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Lavi Kwiatkowsky
by Lavi Kwiatkowsky

Strategies for the EOM and Outcome-Based Care Delivery

Three key takeaways on preparing for the Enhancing Oncology Model (EOM) and what to do during the gap year

Are you currently evaluating the Enhancing Oncology Model (EOM) or other value-aligned payment programs? Canopy hosted a virtual panel discussion on strategies for the EOM and outcome-based care delivery, featuring thought leaders in community oncology:

  • Mike Kolodziej, MD, VP and Chief Innovation Officer, ADVI Health
  • Beth Page, Director of Compliance, Cancer Specialists of North Florida
  • Jeff Hunnicutt, CEO, Highlands Oncology
  • Lavi Kwiatkowsky, CEO, Canopy 

Here are three key takeaways from the discussion. 

1. Evaluating the EOM: Bring Your A-Game

Since the Center for Medicare and Medicaid Services (CMS) debuted the EOM on June 27, 2022—just days before the sunset of its predecessor, the Oncology Care Model (OCM)—practices have been digesting the news and making evaluations. Here are some key opportunities and challenges based on what we know today: 

Key Opportunities

  • Patient-Centric Care: Adoption of Health-Related Social Needs (HRSN) screening tools and electronic patient-reported outcomes (ePROs) in an effort to deliver more equitable and higher-quality care for patients
  • Patient Attribution Methodology: A more intuitive approach to attribution, with the initial treating practice receiving attribution so long as they have 25% of cancer claims
  • Novel Therapy Adjustment: Calculated separately for the model’s seven supported cancer types versus aggregation across all cancer types 

“What I love about EOM is that it keeps the momentum going with regard to value-based care. With increased focus on double-sided risk, CMMI is asking practices to put their money where their mouth is—and the practices who are willing to take the risk will need the right tools to succeed.”

—Lavi Kwiatkowsky, CEO, Canopy

Key Challenges:

  • Patient Eligibility Limitations: Limited to chemotherapy for seven tumor types (breast cancer, chronic leukemia, small intestine/colorectal cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer) and does not include hormonal therapy (exclusively)
  • MEOS Payment Reduction: MEOS payments lowered from $160 in OCM to $70 (non-dual eligible patients) and $100 (dual-eligible patients)
  • Downside Risk: Practices are required to take on downside risk from the start
  • The Gap Year: EOM will run July 2023 through June 2028, leaving a one-year gap for practices to shoulder patient-care investments and operations without reimbursement

Which practices will participate in the EOM? Time will tell but many OCM participants are at least moving forward with the application process.What is certain is that with higher standards for outcome-based care, lower MEOS payments, and required downside risk, practices choosing to participate will need to bring their A-game for success.

2. Deliver Higher-Quality Care for Your Entire Patient Population

What does bringing your A-game to the EOM look like? According to panelists, operationalizing practice redesign activities in a way that meaningfully impacts both patient outcomes and quality metrics is key.

“We’ve seen compelling evidence that ePROs can improve care, help keep patients connected to the practice and out of the ER between visits, and ultimately increase time on treatment, which are all metrics of focus for CMS.” 

—Mike Kolodziej, MD, VP and Chief Innovation Officer, ADVI Health 

Canopy has published various studies demonstrating the clinical impact of its ePRO Platform in the community oncology setting:

88% ePRO engagement at 6 months¹

22% reduction in ER visits²

22%-45% increased treatment persistence at 3 months³

Still, ePROs alone won’t necessarily move the needle. Implementing a new care tool like ePROs means making shifts to practice workflows, redesigning triage pathways, and gaining staff buy-in. 

"At CSNF, our goal was to provide the very best care and to make sure that our patients did not have to go to the hospital. Our team's primary concern with ePROs was, 'Will our patients be able to navigate this new technology?' I can say that answer was a resounding yes." 

-Beth Page, Director of Compliance, Cancer Specialists of North Florida

Having practice workflow solutions in place—like integrated triage pathways and centralized ticketing for patient communications—enables practices to respond to patients and intervene in a timely, standardized way. In fact, data from Canopy customers show thatpractices using ePROs with integrated triage report an average pathway completion time of just 3-4 minutes.

And while there are eligibility limitations for patients under the EOM, practices can ultimately drive higher-quality care for their entire patient population by implementing patient-centric workflows and care tools like ePROs with integrated triage.

3. Unlock Maximum Value with Multimodal Care Management

What are practices doing during the gap year? Many aren’t waiting. The Center for Medicare and Medicaid Services (CMS) offers other value-aligned payment programs—like Chronic Care Management (CCM) and Principal Care Management (PCM)—that are largely non-overlapping.This means practices can run multiple care management programs and value-based models to reach more patients, subsidize lost MEOS payments, and solve for the gap year and beyond.

“There are differentials in our patient population, so we can run CCM, PCM, and other models using similar processes and the same staff we put in place for OCM. We started with CCM and have seen significant returns in a short period of time.”

—Jeff Hunnicutt, CEO, Highlands Oncology 

Chronic Care Management returns at Highlands Oncology 10 weeks after implementation:

273 new patients identified and enrolled

~$21k in monthly billable care time

>$2MM projected annual revenue opportunity

In Conclusion

For practices choosing to participate in the EOM, start preparing now and think beyond short-term solutions for the gap year in order to be successful. 

Whether or not practices pursue the EOM, there are patient-centric care tools and other payment models that can help drive higher-quality care for patients and success for practices.

Learn More

Schedule a demo with the Canopy team to learn how we can support your organization with value-based care.

1. Cherny, N. I., Parrinello, C. M., Kwiatkowsky, L., Hunnicutt, J., Beck, T., Schaefer, E., Thurow, T., & Kolodziej, M. (2022). Feasibility of Large-Scale Implementation of an Electronic Patient-Reported Outcome Remote Monitoring System for Patients on Active Treatment at a Community Cancer Center. JCO Oncology Practice, 18(12), e1918-e1926. DOI: 10.1200/OP.22.00180

2. Kolodziej, M. A., Kwiatkowsky, L., Parrinello, C., Thurow, T., Schaefer, E. S., Beck, J. T., Cherny, N., & Blau, S. (2022). ePRO-based digital symptom monitoring in a community oncology practice to reduce emergency room and inpatient utilization. Journal of Clinical Oncology, 40(16_suppl), 1508.

Authors observed a 22 percent lower rate of adverse clinical events, specifically emergency room and hospital admission.

3. Parrinello, C., Calkins, G., Kwiatkowsky, L., Schaefer, E. S., Beck, J. T., Ellis, A. R., Blau, S., Telivala, B. P., & Kolodziej, M. A. (2022). Time on treatment is prolonged in patients utilizing an ePRO based digital symptom monitoring platform in the community setting. Journal of Clinical Oncology, 40(16_suppl), 1528. DOI: 10.1200/JCO.2022.40.16_suppl.1528