CMS’ Center for Medicare and Medicaid Innovation recently bid adieu to its voluntary, performance-based Oncology Care Model (OCM) and announced the launch of it’s next generation cancer value-based program—the Enhancing Oncology Model (EOM) — scheduled to begin on July 1, 2023. Over its six-year run beginning in 2016, the OCM fell short of its Medicare cost-savings expectations but set in motion important transformations of cancer care delivery to a more person-centered and data-driven approach. The EOM, which is slated for a 5-year test run through July 2028, will build upon this foundation, incentivizing and holding providers accountable for improving quality of care and reducing costs. Many of our OCM customers believe CMS/CMMI took to heart all of their feedback, so participating sites can continue to build upon the foundational tenets of top-quality cancer care built through the Oncology Care Model (OCM).
A key differentiation in the EOM is its narrower scope, encompassing only Medicare beneficiaries undergoing systemic chemotherapy, not hormonal therapy alone, and for only seven cancer types: breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer. The EOM will incentivize participating practices with performance-based payments for reducing overall costs during six-month episodes of care and will hold them accountable for performance-based recoupment payments when they fail to meet predetermined individualized targets. CMS offers several different financial incentive options to accommodate different practice needs to successfully redesign care and meet savings targets. To determine which model is a best fit, we encourage groups to invest in data insight firms or in-house actuary expertise, if you have access, who can help you predict which financial option works best for your organization.
We encourage all cancer programs to submit a Request for Applications (RFA) by the September 30, 2022 deadline. This application is non-binding and provides your center with target cost savings data that will allow your practice leadership to make an educated decision about whether or not EOM participation will be financially meaningful. The application is brief, and Carevive is happy to assist your team in drafting the required 2,500-word implementation plan, free of charge. Please request a meeting if you are interested in our support to complete your application.
Enhancing Oncology Model: Aligned with the Carevive Mission
The new Enhancing Oncology Model emphasizes “enhancements” that oncology providers must demonstrate to qualify for participation. These enhancements include eight specific “redesign activities” intended to ensure Medicare recipients undergoing treatment for cancer receive care that is patient-centered, individualized, backed by evidence, coordinated across all providers, and delivered in a way that will generate the best possible outcomes for patients.
At Carevive, this is music to our ears, as it reflects regulatory and financial support to improve the patient experience, and we applaud CMS/CMMI for the development of this program. Improving the experience of patients being treated for cancer is our passion, and the central tenet of our mission since our company was founded in 2013. All eight redesign activities are already central components of the Carevive cancer care management platform.
8 EOM Redesign Activities as Central Components of the Carevive Platform
24/7 access to care
Carevive PROmpt® (Patient Reported Outcomes Mobile Platform), our remote symptom monitoring and management platform enables a feasible and scalable methodology for the care team and patients to communicate in-between visits. While this functionality is not 24/7 access, Carevive PROmpt® weekly asynchronous communications should decrease inbound triage calls relating to patient symptoms, which our customers today say are about 20% of all calls, and typically take numerous follow-up conversations to resolve and manage. On-call providers will have access to longitudinal data for a better picture of what the patient is experiencing for more effective and efficient symptom management.
Carevive technology enables several EOM-specified core navigation functions, such as continuously measuring patient satisfaction with the cancer care experience, providing health education via PROmpt® (soon to be across multiple languages), we facilitate linkages to numerous psychosocial programs such as those offered by the Cancer Support Community, and we screen patients for interest in clinical trials, whereby navigators can refer to care teams as medically appropriate. Our rules engine technology enables all these navigation services offered to be centric to individual patient needs.
Our clients use PROmpt® to elicit feedback that informs the care plan (e.g., shared decision-making questionnaires, congruence on treatment goals, screening for social risk factors & HRSNs, geriatric assessments), and our software efficiently generates IOM care management plans and survivorship care plans with personalized required and relevant content.
Use of nationally recognized clinical guidelines
Carevive is releasing evidence-based symptom pathways, the development for which was funded from a Phase I/II multi-year grant Carevive received from the National Cancer Institute Small Business Innovation Research (SBIR) funding, a Cancer Moonshot initiative. We are also discussing partnerships with commercially available oncology pathways to more efficiently bring treatment pathway features to our provider customers.
Use of electronic Patient Reported Outcomes (ePROs)
Carevive PROmpt® (Patient Reported Outcomes Mobile Platform) is Carevive’s proprietary application for remote patient reporting and provider symptom monitoring and management; Carevive uniquely has experience integrating ePROs into routine clinical workflow, and our clients have access to a dedicated Clinical Practice Transformation Advisor to help design an implementation plan based on practice needs and resources.
Screening for health-related social needs
Carevive has digitized psychosocial screening tools. We also have formalized a partnership with Cancer Support Community (CSC) to embed their Cancer Support Source®, a comprehensive psychosocial screening technology, which includes referrals to CSC psychosocial programming.
Use of data for quality improvement
Carevive’s data analytic features, Carevive SMART Data™, can drive continuous quality improvement. Carevive’s Clinical Practice Transformation Advisor helps clients design an outcomes measurement program using Carevive’s downloadable data reports to continuously monitor progress and inform quality improvement that will result in improved cost savings and larger performance payments. As part of the use of data for quality improvement, participants will submit health equity plans to CMS, where EOM participants will detail their evidence-based strategies to mitigate health disparities identified within their beneficiary populations. Our Cancer Support Community partnership and the data both of our systems generate will continuously inform client’s health equity plans.
Use of certified electronic health record (EHR) technology
Carevive integrates with some EHRs; we are looking to expand our EHR integration functionality, based on client needs and bandwidth for technical partnership.
Carevive is Keeping Up with an Evolving Reimbursement Landscape
Also central to the Carevive mission is our longstanding commitment to empower cancer programs to be leaders in cancer care delivery and meet the requirements of an evolving reimbursement landscape. We supported our customers through OCM, and many were top OCM performers who, through the use of the Carevive digital platform, are already positioned to transition to the EOM with no further redesign requirements.
For cancer programs weighing the potential benefits and risks of EOM, Carevive offers an efficient, scalable mechanism for implementing all of the required redesign activities and support to meet or exceed cost-saving targets and maximize performance payments.
In summary, Carevive will be a valuable and trusted EOM partner:
- We are the most comprehensive solution to support practice re-design activities; our services and our partnerships enable a “1-stop shop” EOM solution
- We are scientifically rigorous – the only NCI-funded company in the remote symptom monitoring space, with over 60 scientific presentations
- We have the most real-world e-PRO implementation expertise/experience to support your program’s EOM practice re-design activities
- We could provide clinical services support, as needed
- We are the only commercially available cancer platform with symptom pathways
- We offer data analytic features that drive continuous quality improvement
- Using Carevive will improve provider and patient satisfaction with cancer center services
- We will be your dedicated partners, committed to your EOM success, improving quality of care, and maximizing performance payments