A new cancer-focused payment model demonstration from the Center for Medicare & Medicaid Innovation (CMMI) could create opportunities for palliative care providers.
The goals of the Enhancing Oncology Model (EOM), which went live on July 1, are to improve quality and reduce the cost of cancer care with augmented care coordination. While documents on the model do not specifically mention palliative care, several elements of the model align with that care model, according to the Center to Advance Palliative Care (CAPC).
“The Enhancing Oncology Model has palliative care written all over it — the practices, the oncology practices who are participating,” Allison Silvers, chief of health care transformation at CAPC said at the Hospice News Palliative Care Conference. “They are required to do symptom assessments and then come up with plans to address symptoms and side effects. And they also are required to have care partners that can meet holistic needs. They didn’t come right out and say you need to partner with palliative care but they seem to be pushing people in that direction.”
EOM is a five-year voluntary model, in which participating practices must take into consideration their patients’ preferences and goals for treatment, health equity, social determinants of health and psychosocial health needs.
Participants deliver the care in six-month episodes to patients receiving chemotherapy who have one of seven types of cancer: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma and prostate cancer, according to U.S. Centers for Medicare & Medicaid Services (CMS).
The program is intended to help patients feel better supported in their care, have a clearer understanding of their diagnosis, prognosis and expected outcomes; and adhere to their treatment plan, according to CMS.
Currently, participating providers are located in a number of markets across the country, though many regions have none.
Patients aligned with EOM are to receive 24/7 access to clinicians, patient navigation services and a detailed care plan that includes goals-of-care conversations, discussions of prognosis, treatment options, quality of life, symptom management and psychosocial health needs.
Providers must also screen patients for social determinants of health needs, provide comprehensive, coordinated cancer care and strive for continuous data-driven improvement.
For operators, EOM offers two main avenues for reimbursement, a Monthly Enhanced Oncology Services (MEOS) payment, and a performance-based payment (PBP).
The model is designed to build on lessons learned from a previous demonstration, the Oncology Care Model (OCM), which ended in June 2022.
“In the OCM model they actually wrote in a lot of requirements around access to palliative care,” Fred Bentley, managing director for Medicare innovation at ATI Advisory, told Hospice News at the conference. “That’s another CMMI program that has an obvious palliative care tie-in.”
A key aspect of the demonstration is the ability for participating practices to enter into financial arrangements with individuals or entities called “care partners.” These are Medicare-enrolled providers or suppliers who meet certain criteria, including those who offer palliative care.
The partnership component is consistent with CMMI’s overall approach to palliative care, which to date has been to incorporate potential arrangements for those services into a number of independent models centered around primary care, oncology, accountable care organization (ACO) models and kidney care, among others.
Palliative care is also integrated into the hospice component of the value-based insurance design (VBID) demo, often called the Medicare Advantage carve-in.
“We’re thinking about how we leverage accountable care, primary care models and other models to provide flexibility to do different things, like palliative care. And I think engaging with partners on this is really something that we would encourage,” CMMI Deputy Director Ellen Lukens told Hospice News at the conference. “So today, I would definitely encourage all [providers] who are interested to form partnerships with those organizations that have the levers or flexibilities, because there will be some innovation there that we may be able to build upon.”
