Quality of Care and Research Initiatives in the Enhancing Oncology Model

Day 2 of the Oncology Clinical Pathways Congress opened with four presentations comprising “Session 4: Cancer Care Equity and Collaboration.” Leading off the Saturday morning session was Lee A. Fleisher, MD, CMS Chief Medical Officer, Director, Center for Clinical Standards and Quality, presenting “Measuring and Driving Quality of Care and Research Initiatives in Oncology,” detailing the Centers for Medicare & Medicaid Services Innovation’s (CMS) vision for the future.

CMS serves the public as a partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes, Dr Fleisher explained.

“The role of CMS in the health system, we have a lot of levers: A lot of the laboratory data, ensuring we have good and accurate labs in this country, the quality of reporting programs … and how that interfaces with a lot of our payment work,” he added. “We do coverage decisions, but we wanted to send a clear indication how important it is that these trials include the population that is represented in the Medicare population with respect to diversity and how we use our coverage with evidence development.”

Earlier this week, Dr Fleisher said, CMS published its vision for the future in regard to coverage decisions and quality improvement. This initiative is especially important, given that approximately 1.6 million people are diagnosed annually with cancer, Dr Fleisher said.

The vision for the future is built upon the foundation of CMS.

“These six pillars underlie everything we do,” Dr Fleisher said. “Advancing health equity is number one, and you see that in the enhanced oncology model that underlies our health system; building on the Affordable Care Act and getting to that quality as well as affordable health care; engaging our partners; driving innovation—we want to partner and work very closely with the FDA these days, we really want to ensure that we’re driving that innovation but also ensuring that we’re getting that data back to see whether that innovation had the intended goals; always worried about the sustainability of the program; and the people.”

CMS has a strategic plan, refreshed last year, on its vision for the next 10 years. The goal is a health care system that achieves equitable outcomes through high-quality, affordable, person-centered care.

“One of the goals is this focus by 2030 that every single patient is in an accountable relationship with a provider,” Dr Fleisher said. “The interesting question is, ‘who is that accountable provider?’ I think the oncologist for many patients becomes that accountable provider. We think that’s really critical, and some of the disparities we’ve seen relate to not just within hospitals, which we think is small, but also the facilities and the providers where different groups go to.”

Another goal is a CMS National Quality Strategy that includes, but is not limited to, embedding quality across the care journey, advancing health equity, fostering engagement with stakeholders, promoting safety, and embracing the digital age.

“There really is not a clear strategy that’s national in nature in which there’s alignment between all the payers in the direction we’ve been going in,” Dr Fleisher said.

“Embracing the digital age I think is one of the key points. As we talk about the quality metrics, our hope is, how can we use our data, from a lot of the electronic medical records, pull that down so we can actually get those signals faster, reduce burden on the provider, and we can actually see the outcomes and can we use those quality measures to look at the outcomes of some of those innovations.”

Shifting to the Oncology Care Model (OCM) and its future, Dr Fleisher spoke of the 6-year, voluntary payment and delivery model focusing on innovative payment strategies that promote high-quality, high-value cancer care in Medicare fee-for-service (FFS) beneficiaries who are undergoing chemotherapy treatment. OCM ran from July 1, 2016, through June 30, 2022, and included 126 practices, five payer groups, and more than 10,000 cancer practitioners participating. This accounted for about 25% of the chemotherapy-related care for Medicare FFS beneficiaries in the US.

Looking ahead, Dr Fleisher described CMS’ newest model, the Enhancing Oncology Model (EOM), designed to preserve or enhance the quality of care furnished to beneficiaries undergoing treatment for certain cancer types, and with the expectation to reduce Medicare costs.

EOM is a 5-year, voluntary payment and delivery model that builds on lessons learned from OCM with required downside risk focusing on innovative payment strategies that promote high-quality, equitable, high-value cancer care in Medicare FFS beneficiaries who are undergoing chemotherapy treatment. The planned EOM performance period will run from July 1, 2023, through June 30, 2028.

This model has five key improvements from the OCM: focusing on health equity, screening for health-related social needs, targeting high-risk beneficiaries with specific cancer types, incorporating electronic patient-reported outcomes, and providing personalized patient care.

“We moved heavily into the new model that really focuses on enhancing the oncology model by what we’ve learned; standardizing information technology and care across sites, we really think that’s important; better and faster patient access; reorganizing teams; more complete information,” Dr Fleisher said.