CMS made improvements for the Enhancing Oncology Model (EOM) over the Oncology Care Model (OCM), but there remains a delay in data and the challenge of high-cost, novel therapies, explained Stuart Staggs, vice president, Transformation and Shared Services, McKesson.
While CMS recently made adjustments to the Enhancing Oncology Model (EOM) to entice more practices to join, one thing that hasn’t been addressed yet is the high cost of treatments in oncology. Stuart Staggs, vice president, Transformation and Shared Services, McKesson, explained that when only a few practices have access to novel, expensive therapies, such as chimeric antigen receptor T-cell therapy, that haven’t been broadly adopted yet, there is the concern that these treatments are not being factored in appropriately and they are negatively impacting total cost of care.
He also discussed the delay in results, which had been a challenge in the Oncology Care Model (OCM), the predecessor to the EOM. However, he noted that there has been an improvement here over OCM. Now, CMS is releasing quarterly dashboards, which has more information than the old quarterly feedback reports, which had been more directional.
The challenge remaining is that not all of the information in the dashboard is attributed yet. “So, there might be some noise within that data that can be substantial, like some of those high-cost treatments still being in the cost of buckets for the patients that may be carved out later,” Staggs explained.
He joked that his analytics folks like to ask him, “Do you want the answer right now, or do you want it to be right?” Practices in EOM are getting good information right now compared with how it was under the OCM, but there are some delayed results still.
Finally, he outlined how The US Oncology Network is supporting its practices and all of the models they are taking part in through shared learnings in toolkits around depression, pain management, social needs, and advanced care planning.
“[We’re] trying to make sure that we're embracing everything we're learning from all these programs and putting [it] into those toolkits to say, ‘Here are the best practices we're seeing. Here are some of the best resources and information you can have for your patients and your care teams to do things differently,’” Staggs said.
What's at Stake as Oral Arguments Are Presented in the Braidwood Case? Q&A With Richard Hughes IV
April 21st 2025Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.
Read More
Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
Listen
Orca-T showed lower rates of graft-vs-host disease or infection compared with allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome (MDS) or acute leukemias in the Precision-T trial, Caspian Oliai, MD, MS, UCLA Bone Marrow Transplantation Stem Cell Processing Center, said.
Read More
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
Survey Finds Slow Start on CMS Interoperability Rule Implementation
April 10th 2025With deadlines looming in 2026 and 2027 for compliance with the CMS Advancing Interoperability and Improving Prior Authorization Final Rule, a survey indicates a concerning lack of readiness among payers and providers to meet the new requirements for data sharing.
Read More