At the ASCO 2023 Annual Meeting, Lalan Wilfong, MD, The US Oncology Network, the Woodlands, TX, provided an overview of the Enhancing Oncology Model (EOM) and how it differs from and improves upon the Oncology Care Model. Dr Wilfong discussed the EOM as part of the ASCO panel  “Payment Reform: Lessons Learned From the Oncology Care Model and Implications for the Enhancing Oncology Model.”

Transcript:

Lalan Wilfong, MD: Lalan Wilfong, Senior Vice President of Payer and Care Transformation for the US Oncology Network.

Can you give a brief summary of the Enhancing Oncology Model and how it differs or compares to the Oncology Care Model?

Dr Wilfong: The Enhancing Oncology Model is the next iteration of value-based care from CMMI. It's very similar to the Oncology Care Model in the basic designs, with a few changes. It adds an element around health equity in screening patients for social determinants of health. And it also adds an element of electronic patient reported outcomes, which are both new to the model compared to the Oncology Care Model. EOM also differs because it's looking at a much narrower subset of cancers. The Oncology Care Model looked at pretty much all cancers and all patients getting treated for cancer. But the EOM focuses on seven different cancer types. It has a much more narrow scope.

In what ways do you expect that the EOM will improve on the lessons learned from OCM?

Dr Wilfong: The EOM will improve on the Oncology Care Model by allowing us to focus more on high-risk patients. So those patients that are truly under the care of the oncologist, where the oncologist has full control and management of those patients. It also adds some of the critical elements, I think, in patient care, especially around the social determinants of health, which is a critical need we have to understand and manage that patient population better.

What are some of the advantages for practices implementing the Enhancing Oncology Model?

Dr Wilfong: I believe that payment reform is accelerating in the US, and practices that participate in the Enhancing Oncology Model will have a leg up on being able to manage that payment reform. By focusing their practices on taking risk, it will help them in other reform models that are coming. Plus it also provides more support for patient care, which is a critical need that patients want these days, is to be able to have that full person care delivered to them.

What, if any, challenges do you foresee with the program?

Dr Wilfong: There are a few challenges with the program. The first and foremost is the decreased care management or the Monthly Enhanced Oncology Services, MEOS payments. They decreased that from 160 per member per month down to 70, which is a significant reduction in the funding that it takes to instigate these changes that we need. For example, there was a study that was recently published that estimated it cost about $60 per patient to do a full social determinants of health screening and management program. So if we only are getting $70 to do that and it's costing us a significant amount of money to do these changes, practices won't have the funding they need to do the necessary changes for their practice in managing this patient population, so I do worry about that quite a bit.

I also worry that some of the model changes may not accurately keep up with the rapid advancements we're having in oncology, specifically around bispecific antibodies in myeloma, the radiopharmaceuticals. I'm not for sure the model adequately incorporates the cost and complexity of those patients, so the practices who utilize those therapies will not be at significant risk of having paybacks. Those are really my biggest concerns with the model.

Do you have any final thoughts you'd like to add?

Dr Wilfong: We are living in a time of extraordinary change in oncology, not only from the care that we provide and the outcomes that patients are achieving, but in also how we pay for that care and outcomes. Programs like the Enhancing Oncology Model offer practices the ability to start dipping their toes in the water of how we're going to manage all of this rapid change, because I do believe that the way that we get paid for delivering high quality cancer care will be very different five, 10 years from now than it is today. So we have to start thinking differently about how we manage our practices and how we get paid for the services that we provide in order to deliver high quality cancer care.