You’ve been accepted to the Enhancing Oncology Model. Now what?

The Centers for Medicare and Medicaid Services Innovation Center recently announced approved applicants for the new Enhancing Oncology Model. If your facility has been selected by CMS, are you still weighing your options during the current baseline evaluation period? 

Two deciding factors may include the program data that CMS provides and whether EOM is enough of an improvement over the prior Oncology Care Model to make your investment worthwhile.

Another factor to consider: Will you have the resources in place to conduct a baseline evaluation before EOM’s program start on July 1, 2023?

How EOM differs from OCM

EOM aims to improve the coordination of oncology care, drive practice transformation and reduce Medicare fee-for-service spending through episode-based payment. It includes three major updates:

• Fewer cancer types. Compared with OCM’s 21, EOM will be limited to seven common cancer types: breast, prostate, lung, small intestine/colorectal, multiple myeloma, lymphoma and chronic leukemia.
• Revised baseline price prediction module. It now models prices separately for each of the seven cancer types. Additionally, the impact of comorbidities is modeled with increased specificity, the experience adjustment will take into account practice and regional variability, and the trend factor and novel therapy adjustments have been made cancer-type specific.
• Immediate downside risk requirement. EOM requires participants to take on one of two downside risk arrangements immediately.

For more details on how EOM and OCM differ, read DataGen’s September blog. To see DataGen's key findings and in-depth analysis of EOM’s national baseline and prediction module methodology, watch our recorded webinar.

How to prepare

If these changes sound good, it’s time to prepare. DataGen recommends these five steps:

1. Opt in to receive all program data. When CMS releases EOM participation agreements, opt in for all available data, which under OCM included claims-level data for specific episodes of care.
2. Be ready to process data upon receipt. Have the internal resources or a contracted data vendor in place to begin baseline evaluation before EOM begins. CMS will provide data in the second quarter of 2023.
3. Ensure clinical buy-in. If your practice has established EOM oncology stakeholders/physician champions, you’re more likely to be successful and navigate clinical changes well.
4. Evaluate the target price. Can you deliver episode expenditures that are lower than model targets? Additional EOM differences may make that more likely, including underlying baseline prediction models, trend factors and novel therapy adjustments that are priced separately for each of the seven cancer types.
5. Evaluate expenditures and utilization. Part D drugs, oncology care’s biggest cost driver, will be important. OCM risk adjustment didn’t control drug costs well or very much at all, but EOM’s design may assist your practice more.

How to decide

You become an official EOM participant after signing your participation agreement. This gives you time to evaluate any additional data that help with decision-making. You can stop participating with no risk, effective immediately, at any point prior to the model’s go-live date on July 1, 2023.

The practices that ultimately choose not to participate ­— including those that were a part of OCM — may not see EOM as enough of an improvement to make immediate downside financial risk worthwhile. Those that do participate generally believe they can succeed under the model and want to be at the forefront of oncology care and payment transformation.

Which group will you be in?

Need help with your EOM baseline evaluation? DataGen can provide key insight and consultation to help ensure the best performance, locking in better patient and financial outcomes and ensuring program success.