Ben Jones: Collaboration Between CMMI, Providers, Practices Needed for EOM

True collaboration among the Center for Medicare and Medicaid Innovation (CMMI), physicians, and practices is possible for the Enhancing Oncology Model (EOM), believes Ben Jones, vice president of Government Relations and Public Policy at the US Oncology Network.

Jones presented on federal legislative updates at the Community Oncology Conference hosted by the Community Oncology Alliance (COA).

Transcript

What do you think are the most compelling issues covered at this year’s COA conference?

There's been a lot of themes at this year's conference, more so than any other year that I remember. There's a lot of conversations about PBM [pharmacy benefit manager] and payer mandates that are impacting the ability for practices to take control of the total cost of care.

Everyone is talking about bending the cost curve; everyone is talking about the value-based care approach. But at the same time, they're layering in these mandates that are really handcuffing practices, through patient steerage, white bagging mandates, prior authorization that is excessively delaying care. And it's all of these kind of mandates that are disrupting the practices ability to deliver the care in a timely way that they see fit, which is the most efficient manner that they see fit.

A major topic of discussion at this year’s conference surrounds the EOM. What are the major concerns from US Oncology physicians and practices that you are sharing with CMMI?

The US Oncology Network has been a leader in the Oncology Care Model [OCM]. We take value-based care very seriously. We wanted to be on the forefront, and we were regularly engaged with CMMI to ensure that any value-based care model actually had positive impact not only for the practices, but the patients we serve. And we think that that goal was actually accomplished in the OCM.

We were excited to see the next iteration rollout in the Enhancing Oncology Model. However, there are a couple of factors that we think need to be addressed. I mean, at a very high level, without going into too much detail, you can summarize the EOM fairly simply by saying they want you to do more and they're going to pay you less. That's not always a great recipe for success. Now, they think that they've gotten the MEOS—these Monthly Enhanced Oncology Service payments—they think they've right sized them a little bit lower, but at the same time, they're asking the practices to do a lot more. Whether that's through ePROs [electronic patient-reported outcomes], whether that's through SDOH [social determinant of health] reporting, all of that cost more money at the same time that they're reducing the MEOS payment.

Now, do we think that we've got the perfect answer? Probably needs to have kind of a little bit of a back-and-forth on what [CMMI] truly wants, what data they're willing to provide us to make it easier to comply with some of these new regulations, and then we can figure out what the appropriate payment structure looks like. But at the end of the day, it's not a great recipe for success to have a model that pays you less to do more.

We are optimistic, though. And one thing I will note about CMMI, is they have been a terrific partner in engaging in these conversations. This is not a message that's new. And it's also not one that's often easy to hear. But the folks at CMMI have been terrific at least engaging in that back-and-forth conversation. So, we're hopeful that as the EOM comes as enrollment starts, we do get that kind of back and forth, that true collaboration with CMMI as a partner to make sure it's a successful model.