Over the summer there has been a lot of buzz about the Enhancing Oncology Model (EOM). Articles, webinars, and meetings – all focused on answering the important question of whether to submit an application to participate in EOM. Considering the looming submission deadline, internal planning about the expected effect of EOM on the entirety of your practice and its workflows should be reviewed. EOM’s framework is limited to certain cancer and treatment types, meaning that a percentage of cancer patients will not be eligible for EOM and its associated enhanced services. And while redesigning practice workflows to accommodate EOM is essential, considering the impact of these workflows on the clinic’s operations is equally important. Success with EOM means developing a comprehensive practice plan that includes other value-based care models and care management programs that provide quality care to all patients— creating cost savings, and increasing employee/clinical staff morale.
Expand scope to amplify care
For many clinics, participation in EOM will require a substantial investment. Rather than limiting these services to only EOM patients, successful participants will embrace holistic care delivery transformation for all patients in their practice.
Hiring staff and creating work plans solely focused on EOM patients can lead to inefficiencies and lost opportunities for practices. Both clinicians and patients believe that every patient should be given the same high-quality care across the board regardless of their payer. But focusing solely on EOM can mean differentiating treatment amongst patients based on the receipt of EOM Monthly Enhanced Oncology Services (MEOS) payments. Providing the same types of services, such as care navigation and collecting electronic patient-reported outcomes (ePROs) regardless of whether the patient is in EOM or other care management programs, such as principal care management (PCM) or chronic care management (CCM), can lead to increased staff productivity and improved patient outcomes across your entire patient population. Additionally, in part due to greater buy-in as described below, more and more private payers are entering into value-based care arrangements with practices that often incorporate the same requirements as Medicare programs.
As with OCM, participating clinics are required to develop care plans and provide patient navigation services to EOM beneficiaries. These activities are valuable services that enable better patient care through meaningful communication, joint planning and buy-in from the patient, and linkages with other important patient resources. Many of these same activities fall under the care management services covered under Medicare’s PCM and CCM programs, allowing clinics to recoup staff costs and receive reimbursement for these valuable services for non-EOM beneficiaries. Further, creating parallel and similar systems enable staff efficiencies by eliminating context switching. Nursing staff and care navigators can establish processes that accommodate all (or most patients) regardless of the Medicare program the patient is enrolled in.
An important and new component of EOM is the utilization of ePROs. CMMI has embraced the usage of ePROs as a key lever for increasing patient satisfaction, decreasing costs, and addressing health-related social needs. The usage of ePROs has shown improvement in patient satisfaction, a decrease in patient toxicities, and a reduction in costs associated with hospital and emergency room visits.
Many clinics today utilize ePROs to better assess patient medication adherence and symptoms and provide augmented patient care services through Navigating Cancer’s Health Tracker. Integrated with our triage management solution, nurses can readily identify, in real-time, patients who experience toxicities and need immediate care, or preemptive interventions. Utilization of ePROs across the spectrum of patients will enable standardized workflows and consistent, high-quality patient care regardless of EOM beneficiary status. And ultimately the usage of ePROs can lead to reduced patient costs and better patient outcomes. Further, pending changes in the Medicare Physician Fee Schedule pertaining to remote therapeutic monitoring, may allow Medicare reimbursement for ePRO activities and associated patient monitoring
A key component of a successful EOM and care management program is getting buy-in from private payers. CMMI recognizes this goal by inviting private payers to participate in EOM as well. Encouraging private payers to either participate in EOM or develop similar strategies and initiatives will help practices develop consistent workflows, provide high-value care across the entire patient population, and reduce staff burnout. Gaining early alignment with private payers will help with the planning and optimization of clinic workflows and ensure patient-focused care for all patients, regardless of payer.
EOM is months away and in the meantime utilization of CCM and PCM will help practices prepare for the enhanced services required by EOM. Establishing workflows and triage procedures prior to commencing EOM and determining how to consistently manage multiple patient populations will be a key component of obtaining the shared savings intended by EOM.
Learn How to Harness
EOM for All Patients
To learn more about succeeding with EOM and other value-driven care programs, register for the upcoming Navigating Cancer webinar: “Are You Ready for EOM? How to Succeed Financially with Value-Driven Care”.
 Mir O, Ferrua M, Fourcade A, et al. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med. 2022;28(6):1224-1231. “The CAPRI study, a digital, nurse navigator-led intervention, has been able to show a positive effect on the triple aims of healthcare interventions through an improvement of patient experience of care (that is, the PACIC score); the health of the target population (that is, a decrease of grade ≥3 toxicities from 36.9% of patients to 27.6% of patients); and cost control (that is, a decrease in days of hospitalization from a mean (s.d.) of 4.44 (9.60) to 2.82 (6.96)).”