Biden Administration Unveils New Model to Improve Cancer Care for Medicare Patients

Through the United States (US) Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), the Biden Administration has announced a new model, the Enhancing Oncology Model (EOM), aimed at improving cancer care for Medicare and Medicaid patients and lowering health care costs.^1,2

The EOM was designed to improve the ability of health care providers to deliver care centered around patients, consider patients’ individual needs, and provide cancer care to patients in a way that will generate the best possible outcomes. The model centers around supporting and learning from cancer patients, caregivers, and cancer survivors.

Additionally, the EOM will address inequities between patients and provide treatments that address their unique needs. This new model supports President Joseph R. Biden’s Unity Agenda and Cancer Moonshot initiative which both look 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 Xavier Becerra, secretary of the US Department of Health and Human Services, in the press release. “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.”

Previously, the Innovation Center’s Oncology Care Model was tested from July 1, 2016 through June 30, 2022. This voluntary EOM comes from what was learned in the previous model and plans to run for 5 years.

Included in the model are 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. Participating providers will also provide enhanced services to support health care transformation. This includes patient navigation, care planning, collection of electronic patient-reported outcomes (ePROs), and screening for social needs that may affect treatment, such as transportation issues, nutritional needs, and more.

Additionally, the EOM will also encourage other payers such as commercial payers and state Medicaid agencies, to match their needs with its core concepts to allow for a consistent approach between the payers and EOM participants’ patient population.

In March 2022, President Biden relaunched the Cancer Moonshot program with the intent of reducing the cancer death rate by at least 50% over the next 25 years. Further, the program looks to improve the experience of these patients, and ultimately eradicate the disease.

Now, the Biden administration has made the Cancer Moonshot part of its health care agenda, which also prioritizes lowering health care costs and expanding patient coverage. Goals of this program include diagnosing cases earlier, addressing environmental exposures, dealing with inequities in access to treatment, accelerating the fight against pediatric cancers, and learning from the experiences of all patients.

As previously stated, the main goal of EOM is to provide better support for patients with cancer and improve their care experience. The EOM will advance a key goal of the Cancer Moonshot Initiative.

With the EOM patients will have an opportunity to share feedback on their overall cancer care experience and health outcomes as the model aims to improve communication among patients, oncologists, and care teams in the time between appointments. This will hopefully allow patients to easily reach their health care providers so their questions can be answered.

Further design elements of the EOM include 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, and requiring participating providers to develop plans showing how they will address health equity gaps in their patient population.

As for the Association of Community Cancer Centers (ACCC), they are hopeful that this EOM will allow their programs and practices to improve in their value-based care transformation journeys as they continue to deliver patients high-quality, equitable, and affordable cancer care.³

References:

1. Biden administration announces new model to improve cancer care for Medicare patients. News release. Centers for Medicare & Medicaid Services. June 27, 2022. Accessed July 06, 2022. https://go.cms.gov/3RffKOr

2. Community oncology alliance statement on the enhanced oncology model. News release. Community Oncology Alliance. June 27, 2022. Accessed July 06, 2022. https://bit.ly/3yIvwKz

3. ACCC statement on the enhancing oncology model. News release. The Association of Community Cancer Centers. June 29, 2022. Accessed July 06, 2022. https://bit.ly/3NIoLfT