The Evolving Landscape of Oncology Payment Models: challenges and Uncertainties wiht the EOM
the shift from the Oncology Care Model (OCM) to the Enhancing oncology Model (EOM) has brought notable changes – and challenges – to oncology practices nationwide. Recent discussions among industry leaders reveal a growing sense of instability and administrative burden, raising questions about the long-term viability of value-based care in cancer treatment. This article dives deep into these concerns, offering insights for practices navigating this complex surroundings.
From OCM Successes to EOM Headwinds
The OCM,launched in 2016,demonstrated promising results. Practices participating in the OCM achieved cost savings, particularly through the adoption of biosimilars and innovative treatment regimens. For example, the recent FDA approval in July 2024 of a 4-drug regimen for multiple myeloma – following positive data from the PERSEUS trial presented in December 2023 – highlights the rapid advancements in cancer care that OCM helped facilitate.
Though, the transition to the EOM hasn’t been seamless. Several key factors are contributing to a more uncertain landscape.
Key Challenges Facing Practices Today
Here’s a breakdown of the major hurdles practices are encountering with the EOM:
* Disrupted Biosimilar Market: The biosimilar market, once a source of significant cost savings under OCM, is now facing disruption. More expensive biosimilars and the emergence of 505(b)(2) drugs (non-interchangeable competitors) are eroding previous cost advantages.
* data Lag & Lack of Real-Time Insights: A persistent issue remains: the significant delay between when care is delivered and when practices receive performance data. How can you effectively adjust strategies when results are months behind? As one panelist put it,the EOM feels like “a nicely designed map without a compass.”
* Administrative Burden: The EOM’s administrative requirements are significant, especially as opportunities for performance-based payments diminish. You’re likely facing a patchwork of programs from commercial payers and Medicare Advantage plans, each demanding individual navigation.
* Manual Data Extraction: Despite automation efforts, extracting the necessary data for reporting remains a largely manual process. this consumes valuable time and resources.
* Alignment Issues: Attempts to align EOM requirements with programs like the Merit-based Incentive Payment System (MIPS) haven’t fully resolved the issue of overlapping and conflicting reporting demands.
The Impact of Delayed Data & Unpredictable Trends
The lack of real-time data is particularly concerning.Oncologists are forced to make treatment decisions based on what’s best for the patient, payer coverage, and drug availability - without knowing how these choices will impact their performance in the EOM. This unpredictability makes it challenging to compare your practice’s performance against national benchmarks.
you’re likely grappling with these questions:
* How will drug pricing fluctuations affect trend factor calculations?
* What’s happening nationwide with drug utilization, and how does that impact my practice?
* will my performance be accurately reflected given these external factors?
Participation in EOM: A Critical Decision Point
the EOM currently includes fewer practices than the OCM did at its peak (38 listed on the website versus OCM’s initial 200+). Many practices are now re-evaluating their participation, with a decision deadline of november 30th.
The sentiment among leaders is cautious.While some, like one practice administrator, plan to remain in the program for now, others are conducting thorough analyses to determine if continued participation is financially sustainable. The bottom line, as one expert stated, is ensuring “we have to keep the doors open.Otherwise, patients don’t get care.”
What This Means for Your Practice
The evolving landscape of oncology payment models demands a proactive approach. Here are some steps you can take:
* Thoroughly Analyse EOM Performance: Don’t just participate – actively monitor your performance data and identify areas for advancement.
* Stay Informed About Market Changes: Keep abreast of developments in drug pricing, biosimilar availability, and payer policies.
* Streamline Administrative Processes: Invest in tools and resources to automate data extraction and reporting as much as possible.
* Advocate for Change: Engage with CMS and other stakeholders to advocate for improvements to the EOM, such as more timely data reporting and reduced administrative burden.
