- The Biden administration has unveiled a voluntary five-year program offering additional payments to oncology practices that improve services to Medicare and Medicaid patients, part of a broader effort to achieve a national goal of lowering the death rate from cancer by at least 50% over the next 25 years.
- The Enhancing Oncology Model requires participating providers to offer services including patient navigation, 24-hour access to a clinician, a detailed care plan and screening for social needs that may affect treatment such as transportation and nutritional issues, the CMS said.
- Collection of electronic patient-reported outcomes will allow patients to provide feedback on their care and health outcomes. Oncology practices are also required to report patient demographic data, including race, ethnicity, language and gender identity, and to develop plans showing how they will address health equity gaps.
Developed at the CMS Innovation Center, the incentive program is part of a renewed push by the Biden administration announced earlier this year to accelerate the ambitious Cancer Moonshot effort to cut cancer mortality in half.
Biden launched the Cancer Moonshot as vice president in 2016. The initiative became law with the 21st Century Cures Act, enacted five years ago, which provided $1.8 billion in funding over seven years for research initiatives including studies on cancer disparities, new clinical trial networks to drive drug discovery and projects examining childhood cancer. The law also streamlined cancer-related decision-making at the FDA through the formation of an Oncology Center of Excellence.
With the Enhancing Oncology Model, the administration will offer additional payments to practices that provide the program's specified services to Medicare and Medicaid patients and meet its reporting requirements. Commercial payers and state Medicaid agencies will be encouraged to align with the program's core concepts, the CMS said.
"The Enhancing Oncology Model will incentivize participating oncology practices — including those in rural and underserved areas — to improve the provision of high quality, coordinated care that addresses patients’ social needs and improves patient and caregiver support,” CMS Administrator Chiquita Brooks-LaSure said.
The program aims to improve communication between patients, oncologists and care teams between appointments and help patients reach their healthcare providers more easily, the agency said.
The CMS will give participants the option to bill for a monthly enhanced oncology services payment for enhanced services provided to eligible beneficiaries. The payment will be higher for beneficiaries dually eligible for Medicare and Medicaid.
Program participants can also earn a retrospective performance-based payment based on quality and savings. Oncology practices will be required to take on downside risk from the start of the model with the potential to owe the CMS a performance-based recoupment of expenses.
The voluntary model is open to oncology practices that treat Medicare patients undergoing chemotherapy for breast cancer, chronic leukemia, lung cancer, lymphoma, multiple myeloma, prostate cancer and small intestine/colorectal cancer. The program will run from July 2023 through June 2028.
Earlier this month, HHS announced funding awards of $215 million as an initial step in a five-year, $1.1 billion investment in three national programs to prevent and control cancer. In May, HHS announced the availability of $5 million for community health centers, funded by the agency's Health Resources and Services Administration, to increase equitable access to life-saving cancer screenings.