Biden Administration to Launch Specialty Payment Model
By Emma Freer


A new, voluntary Medicare payment model option focused on cancer care opens the value-based care door wider for specialists at a time when such models have been limited.

The Enhancing Oncology Model – which will begin on July 1, 2023, and last for five years – also aligns with the Biden administration’s Cancer Moonshot initiative, which aims to halve the cancer death rate in the U.S. over the next 25 years.

Susan Escudier, MD, vice president of value-based care and quality programs for Texas Oncology, welcomes the news.

“We’re very interested in continuing in the value-based care models,” she said.

Under the Enhancing Oncology Model, participating oncology practices will be accountable for their patients’ health care outcomes and costs over six-month episodes, according to the Centers for Medicare & Medicaid Services (CMS). In exchange, they will receive a monthly per-patient payment on top of fee-for-service payments. Depending on their performance, practices also may earn an incentive payment or incur a financial penalty.

The Enhancing Oncology Model focuses on what CMS says is typically a high-cost area of care and draws on the Oncology Care Model, a previous iteration that ran from July 2016 through June 2022.

Dr. Escudier, whose cancer practice was one of the largest in the U.S. to participate in the Oncology Care Model, says the Enhancing Oncology Model is different in a few key areas. Namely, it limits practices to developing care plans for Medicare patients receiving systemic chemotherapy for seven kinds of cancer, whereas the Oncology Care Model allowed for chemotherapy care plans for most cancers. According to CMS, the seven kinds of cancer eligible under the new model are:

  • Breast cancer;
  • Chronic leukemia;
  • Small intestine/colorectal cancer;
  • Lung cancer;
  • Lymphoma;
  • Multiple myeloma; and
  • Prostate cancer.

The Enhancing Oncology Model also will require participants to implement certain activities, including screening for nonmedical drivers of health and evidence-based strategies to mitigate health disparities among their patient population, a new focus for CMS in its value-based care initiatives.

Dr. Escudier’s practice has adopted some of these protocols already. But the new model offers a chance to build on some of the progress made under the Oncology Care Model – such as incorporating pain assessment and treatment planning – while embracing value-based care more fully.

There is a one-year gap between the end of the Oncology Care Model and the start of the Enhancing Oncology Model. Dr. Escudier says this interim period will help ease the transition.

For example, under the new model, participating practices will have to screen eligible Medicare patients for nonmedical drivers of health, such as food insecurity and transportation access. Over the next 11 months, aspiring participants may hire social workers and establish relationships with community organizations that would help connect at-risk patients with resources, where appropriate.

“We’re going to have to formally collect the [nonmedical drivers of health] data,” Dr. Escudier said, adding that this requirement will help practices identify patients in need of additional support. “I think that’s a good thing.”

Oncology practices interested in participating in the Enhancing Oncology Model must submit applications via the CMS Innovation Center by 10:59 pm CT on Sept. 30. The center hosted a webinar about the new model on June 30. A recording is available on its website.

And for the latest developments in value-based care and a toolbox to help practices navigate the topic, check out the July issue of Texas Medicine.

Last Updated On

July 27, 2022

Originally Published On

July 27, 2022

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Medicare | Quality of Care

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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