Enhancing Oncology Model (EOM)
Model Summary
1. Executive Summary and Strategic Context
The Enhancing Oncology Model (EOM) is a nationwide voluntary payment model testing value-based oncology care for Medicare beneficiaries receiving systemic chemotherapy for seven specific cancers: high-risk breast cancer, lung cancer, chronic leukemia, small intestine/colorectal cancer, lymphoma, multiple myeloma, and high-risk prostate cancer. Cohort 1 launched July 1, 2023 (7 years); Cohort 2 began July 1, 2025 (5 years). Both end June 30, 2030.
With 34 participating practices and 1 payer, EOM succeeds the Oncology Care Model (OCM, 2016-2022) and incentivizes oncology providers to take accountability for total cost of care during 6-month chemotherapy episodes. CMS released the first reconciliation performance data and first annual evaluation report on August 25, 2025, providing initial evidence of model impact.
1.1 Strategic Significance
EOM represents CMS's most developed specialty care value-based model. Oncology is the second-highest cost category in Medicare, with novel agents (immunotherapy, targeted therapy, CAR-T) driving rapid spending growth. EOM tests whether episode-based accountability can constrain costs while improving patient-centered care through navigation, care planning, and enhanced end-of-life support. The new Substance Access Beneficiary Engagement Incentive in PP6 signals continued model evolution.
2. Model Architecture
2.1 Episode Definition
Trigger: First qualifying systemic chemotherapy claim for an EOM-covered cancer type.
Duration: 6 months from trigger date or until patient death.
Attribution: Episode attributed to the EOM participant practice that initiates or manages chemotherapy.
2.2 Covered Cancer Types
| Cancer Type | Risk Level | Key Cost Drivers |
|---|---|---|
| Breast Cancer | High-risk only | CDK4/6 inhibitors, immunotherapy, genomic testing |
| Lung Cancer | All systemic | Immunotherapy (pembrolizumab, etc.), targeted agents |
| Chronic Leukemia | All systemic | BTK inhibitors, long treatment duration |
| Small Intestine/Colorectal | All systemic | Bevacizumab, FOLFOX/FOLFIRI regimens |
| Lymphoma | All systemic | CAR-T cell therapy, R-CHOP variants |
| Multiple Myeloma | All systemic | Lenalidomide, bortezomib, daratumumab combinations |
| Prostate Cancer | High-risk only | Enzalutamide, abiraterone plus chemotherapy |
2.3 Payment Components
Monthly Enhanced Oncology Services (MEOS) Payment: Per-beneficiary-per-month payment for enhanced services: care coordination, patient navigation, 24/7 access, treatment planning. Billed monthly during episodes using designated HCPCS codes.
Episode-Based Performance Payment: Reconciliation of actual episode spending against target prices. Practices below target share savings; those above may owe losses depending on risk arrangement.
Substance Access Beneficiary Engagement Incentive (New PP6): New payment supporting beneficiary access to substance use treatment resources, reflecting growing intersection of oncology and behavioral health.
2.4 Risk Arrangements
EOM offers two-sided risk with shared savings and shared losses. Practices take financial accountability for total episode spending (chemotherapy, hospitalizations, ED visits, supportive care, post-acute care) against a benchmark target price.
3. Quality and Care Delivery Requirements
3.1 Required Enhanced Services
Personalized Care Plans: Documented treatment plans covering diagnosis, treatment goals, expected side effects, advance care planning, and psychosocial support needs.
Patient Navigation: Dedicated navigator to guide patients through treatment, coordinate referrals, address barriers to care, and facilitate communication between providers.
24/7 Patient Access: Around-the-clock clinician access for urgent symptom management to reduce unnecessary ED visits and hospitalizations.
End-of-Life/Goals of Care: Required discussions and documentation of patient preferences, advance directives, and hospice eligibility assessment.
3.2 Quality Measures
EOM quality performance is assessed across domains including: patient experience (surveys), clinical quality (appropriate use criteria), care process measures (advance care planning documentation, hospice referral timing), and utilization (ED visits, hospitalizations per episode). Quality scores may adjust reconciliation payments.