New Model to Improve Cancer Care for Medicare Patients

Enhancing Oncology Model Aims to Improve Patient-Centered Care, Lower Health Care Costs, and Address Health Equity as Part of President Biden’s Cancer Moonshot

The Biden Administration, through the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), announced a new model aimed at improving cancer care for Medicare patients and lowering health care costs. CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) designed the Enhancing Oncology Model (EOM) to test how to improve health care providers’ ability to deliver care centered around patients, consider patients’ unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes. The model will focus on supporting and learning from cancer patients, caregivers, and cancer survivors, while addressing inequities and providing patients with treatments that address their unique needs. This new model supports President Joe Biden’s Unity Agenda and Cancer Moonshot initiative to improve the experience of people and their families living with and surviving cancer.

“No one should have to battle cancer without access to high quality, coordinated care,” said HHS Secretary Xavier Becerra. “With this new Innovation Center model for oncology care, we are delivering on President Biden’s call to action to mobilize every option to address cancer, and creating a system of care that supports all patients and their families. We will continue to do all we can to make access to this care equitable and end cancer as we know it.”

“There are stark inequities in the ability of people with cancer across race, gender, region, and income to access cancer screening, diagnostics, and treatment,” said CMS Administrator Chiquita Brooks-LaSure. “CMS is working to advance President Biden’s Cancer Moonshot goals by helping Medicare cancer patients better navigate a challenging and often overwhelming journey. The Enhancing Oncology Model will incentivize participating oncology practices – including those in rural and underserved areas – to improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support.”

Building on the lessons learned from the Innovation Center’s Oncology Care Model (tested from July 1, 2016 – June 30, 2022), EOM is a voluntary model that will run for five years, from July 2023 through June 2028. Model participants will include oncology practices that treat people with Medicare undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer, and small intestine/colorectal cancer.

To support health care transformation, participating providers will also provide Enhanced Services such as patient navigation, care planning, collection of electronic patient-reported outcomes (ePROs), and screening for social needs that may affect treatment, such as transportation issues and nutritional needs. EOM will also encourage other payers (e.g., commercial payers, state Medicaid agencies) to align with its core concepts to promote a consistent approach across payers and EOM participants’ patient population.

The central goal of EOM is to better support patients and improve their care experience, advancing a key goal of the Cancer Moonshot Initiative. Oncology practices who participate in EOM can expect to provide patient-focused Enhanced Services, such as 24/7 access to a clinician, patient navigation services, a detailed care plan, and screenings for health-related social needs. Patients will also have an opportunity to share feedback on their overall cancer care experience and health outcomes. EOM aims to increase and improve communications among patients, oncologists, and care teams in-between appointments and enable patients to more easily reach their health care providers with questions.

In addition to requiring participants to screen for health-related social needs, EOM includes other design elements that help drive CMS’ commitment to advancing health equity, including:

• Offering an additional payment to participating oncology practices that provide Enhanced Services to patients who qualify for both Medicare and Medicaid,
• Requiring participating providers to report patient demographic data (e.g., race, ethnicity, language, gender identity), and
• Requiring participating providers to develop plans showing how they will address health equity gaps in their patient population.

President Biden has reignited the Cancer Moonshot and set new national goals: if we work together, we can cut the death rate from cancer by at least 50% over the next 25 years, and improve the experience of people and their families living with and surviving cancer — and, by doing this and more, end cancer as we know it today.

Earlier this month, HHS announced first-year funding awards of $215 million in a five-year, $1.1 billion investment into three national programs to prevent and control cancer. In May, HHS announced the availability of $5 million for community health centers, funded by HHS’ Health Resources and Services Administration, to increase equitable access to life-saving cancer screenings.

A fact sheet on EOM is available.

For oncology practices interested in participating in EOM, view the Request for Applications. All EOM applications must be submitted by 11:59 pm Eastern Daylight Time on September 30, 2022.

View more information on the Enhancing Oncology Model.