Will Biden’s “Enhancing Oncology Model” Improve Outpatient Care for Medicare Patients?

Patricia Jakel, MN, RN, AOCN

In June 2022, President Joseph R. Biden announced the launch of a new model aimed at improving oncology care for Medicare patients while lowering costs.¹ This model is being developed as part of the Cancer Moonshot program, and through the US Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services.

As oncology nurses know, cancer is one of the most common and devastating diseases in the United States. More than 1.9 million individuals are expected to receive cancer diagnoses in the United States in 2022. Moreover, cancer was the second leading cause of death in the nation but was the leading cause of death for men and women aged 60 to 79 years, many of whom are Medicare patients.²

There are many examples of disparities in cancer care, including delays in initiation of chemotherapy, more advanced stages of diagnosis, underrepresentation in and access to clinical trials, decreased medication adher- ence, more frequent hospitalizations and intensive care unit admissions near the end of life, and lower enroll- ment in hospice.

The new program, named the Enhancing Oncology Model (EOM), will test how to improve care by considering patients’ unique circumstances and delivering evidence-based care to allow for the best possible outcomes. The objective behind the EOM is to “drive transformation in oncology care by preserving or enhancing the quality of care furnished to beneficiaries undergoing treatment for certain cancer types, with the expectation that such transformations will reduce Medicare expenditures.”

Specifically, the goals behind the EOM are as follows^3,4:

• Put the patient at the center of a care team that provides equitable, high-value, evidence-based care
• Build on Oncology Care Model lessons learned and continue the value-based journey in oncology, which is a historically high-cost area of Medicare spending
• Increase engagement of patients, oncologists, and other payers (eg, state Medicaid agencies, commercial payers) in value-based care and quality improvement
• Observe improved care quality, health equity, and health outcomes as well as achieve savings over the course of the model test

In a news release, Xavier Becerra, secretary of HHS, stated, “With this new Innovative Center model for oncology care, we are delivering on President Biden’s call to action to mobilize every option to address cancer and create a system of care to support all patients and their families. We will do all we can to make access to this care equitable and end cancer as we know it.”

The EOM is built on lessons learned from Innovative Center’s Oncology Care Model (July 2016-June 2022) and will be voluntary and will run for 5 years, July 2023 to June 2028. EOM will include practices that treat patients with Medicare undergoing chemotherapy for 7 common cancer types: breast cancer, leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

For clinics or infusion centers participating in the inno- vation, patients can expect 24/7 access to an appropriate clinician with real-time access to your medical records; patient navigation services; a detailed care plan that involves your engagement and preferences on discussions surrounding prognosis, treatment options, symptom management, quality of life, and psychosocial health needs, among other topics; screening for health-related social needs (related to food, transportation, housing, etc); and questions regarding the overall cancer care experience and health outcomes, such as those related to symptoms, physical functioning, and behavioral health.

EOM is a 6-year, voluntary payment and delivery model launching on July 1, 2023, and will focus on innovative payment strategies that promote high-quality and high-value cancer care in Medicare patients with a cancer diagnosis who are undergoing chemotherapy treatment. The scope of the innovation will encompass 126 oncology practices and 5 payers. Combined, these institutions account for approximately 25% of chemotherapy-related care for Medicare patients in the United States.

To nurses fortunate enough to work in the 126 practices selected to participate in this 5-year study, we thank you. As oncology nurses, we look forward to seeing all patients—across all races, genders, regions, and incomes—have access to cancer screening, diagnostics, and treatment.

Ideally, the knowledge generated through EOM will result in improved communication, 24/7 access to care, assessment of social needs, and overall improved outcomes for patients.

References

1. Biden administration announces new model to improve cancer care for Medicare patients. Centers for Medicare & Medicaid Services. June 27, 2022. Accessed November 14, 2022. https://go.cms.gov/3TCjr0K
2. Risk of dying from cancer continues to drop at an accelerated pace. American Cancer Society. January 12, 2022. Accessed November 14, 2022. https://bit.ly/3tssLJJ
3. Enhancing Oncology Model. Centers for Medicare & Medicaid Services. Updated November 8, 2022. Accessed November 14, 2022. https://bit.ly/3UZL2tT
4. Fact sheet: Enhancing Oncology Model. Centers for Medicare & Medicaid Services. June 27, 2022. Accessed November 14, 2022. https://go.cms.gov/3X0k4nw