In The News,
In The News,
The Enhancing Oncolgy Model (EOM) is a 5-year, voluntary Alternative Payment Model (APM) advanced through the Centers for Medicare and Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI). It is a total cost of care model, based on a 6-month episode of care, which forces oncology providers to evaluate the relative value of drugs and services within the episode. The EOM is limited to seven cancer types including breast, chronic leukemia, small intestine/colorectal, lung, lymphoma, multiple myeloma, and prostate. The model combines fee-for-service (FFS) payments with two model-specific payment components.
Using SAVEs access to 100% Medicare FFS data from CY 2016-2020, we replicated CMMI’s EOM methodology to identify lung cancer episodes based on the initiation of chemotherapy and immunotherapy. We attributed beneficiaries to participating physician groups and calculated the total episode cost, target price, and assessed episode metrics of PD-L1 utilization, inpatient hospitalizations, and emergency room use.
ADVI SAVEs assessment found that PD-1/PD-L1 were utilized in 53 percent of lung cancer episodes, and the use of various PD-1/PD-L1 products shifted over time. The pharmaceutical company used the results of the assessment to better understand payment dynamics within lung cancer episodes in EOM.
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