CMS to launch new oncology payment model under Medicare

The Biden administration will launch the next phase of its Cancer Moonshot initiative next July with a new value-based oncology payment model through Medicare that aims to improve cancer care outcomes and lower costs nationwide.

CMS will run the Enhancing Oncology Model from July 2023 to June 2028 and will study how to improve providers' ability to deliver whole-person cancer care. Participants in the voluntary model will include oncology providers that treat Medicare patients undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer and small intestine/colorectal cancer, according to a June 27 news release.

Oncology physician group practices, commercial payers, Medicare Advantage plans and state Medicaid programs located anywhere in the U.S. are encouraged to apply through Sept. 30. 

Oncology practices that participate in the EOM can expect to provide 24/7 access to a clinician, patient navigation services, a detailed care plan and screenings for health-related social needs. They must use evidence-based guidelines, electronic patient-reported outcomes, data for quality improvement and certified EHR technology. Patients will be able to share feedback on their experience and health outcomes and will face no cost-sharing for the services.

Beyond the monthly payment for providing the enhanced services, participants can also earn a retrospective payment for performance based on care quality and savings. CMS can also recoup payments based on performance, and participants will have to take on downside risk from the start.

To improve health equity, the new model will include an additional payment for participating providers that offer the new services to patients who qualify for both Medicare and Medicaid. Providers will be required to report patient demographic data and develop a plan showing how they will address health equity gaps among their patients.

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