The Key Factors Driving Low Participation in the Enhancing Oncology Model

Abstract

This study investigates the challenges leading to a substantial de­cline in participation among academic oncology practices within the Enhancing Oncology Model (EOM), introduced as a successor to the Oncology Care Mod­el (OCM) by the CMS Innovation Center. Analyzing the withdrawal of 14 practic­es from the EOM, previously part of the OCM Collaborative, three primary factors are identified: immediate downside risk in a context of narrow provider margins, inadequate risk adjustment failing to appropriately account for drug costs, and onerous reporting burdens for extensive clinical data. Under the EOM, immedi­ate downside risk for seven specified cancers diverged significantly from the OCM’s upside-only risk structure, posing financial challenges for practices. Inad­equate risk adjustment, particularly the omission of crucial clinical data, raised concerns about the model’s focus on drug costs without considering essen­tial patient-specific variables. The study also highlights the burden of reporting requirements, exacerbated by reduced enhanced services payments, impacting practices financially. To address these challenges and encourage EOM participa­tion, policy options are proposed. These include reconsidering financial risk lev­els, refining target price methodology to incorporate clinical data, and reducing reporting burdens by aligning data requirements with EOM financial and quality methodologies. These adjustments aim to strengthen the EOM, fostering more accurate performance measurement and incentivizing high-quality patient care delivery in oncology practices.