CMMI Announces Enhancing Oncology APM

Earlier this year, President Joe Biden relaunched his Cancer Moonshot Initiative, which was initially established under the Obama administration to accelerate research into cancer prevention and cures. As part of the initiative, the Biden administration announced a new alternative payment model (APM) from the Center for Medicare and Medicaid Innovation (CMMI) which will incentivize providers in oncology to provide whole-patient care rather than strictly cancer care.

The model, called the Enhancing Oncology Model (EOM), includes principles of value based care (VBC) and will aim to increase care quality by addressing a patient’s whole health and social needs while reducing care inequities and overall cost.

According to RevCycle Intelligence, EOM will launch in July 2023 and end in June 2028. It will be based on a bundled payment structure and participating practices will receive a monthly capitated payment to provide a broad spectrum of services to patients including screenings for social determinants of health, patient navigation, care planning, implementation of electronic Patient-reported Outcomes (ePROs) and the promotion of health equity.

Participating practices will be responsible for the quality of a patient’s health for six-month episodes of care. Participants may earn a performance-based payment or owe a performance-based recoupment if total expenditures extend beyond a designated threshold. These providers may also bill an additional $70-per-patient-per-month if extra services like 24/7 access to clinicians, patient navigation services and other screenings are provided, Modern Healthcare reports.

Private insurers, Medicare Advantage plans and state Medicaid agencies may also apply to participate and enter into a memorandum of understanding to conduct the model within their own programs. The application period began on Monday and will remain open through September.

From Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure:

There are stark inequities in the ability of people with cancer across race, gender and region, and income to access cancer screening, diagnostics and treatment. CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey.

Read the full EOM Fact Sheet at CMS.