Chat GPT on Cancer Care Model v1 v2 at CMMI

 User

I understand that CMS ran an Oncology Care Model or OCM as one of the earlier experiments of CMMI, the Center for Innovation.  I understand the results were not much, but I'd be happy to hear if different.  Now there is some kind of second generation CMS OCM, what is it and what are the updates or differences?

ChatGPT

The original Oncology Care Model (OCM) launched by the Center for Medicare and Medicaid Innovation (CMMI) in 2016 aimed to improve care coordination and patient outcomes for cancer patients. However, the results of the OCM have been mixed. Financially, the model did achieve some savings, but these were offset by the costs of the program. A study by the Centers for Medicare & Medicaid Services’ OCM Evaluation Team found that the OCM led to a $499 relative savings in OCM versus comparison episodes. Despite these savings, the overall impact on the quality of oncology care was minimal, with only a small decrease in hospitalizations in the last month of life but no significant improvements in other quality measures, such as emergency department visits and patient-reported outcomes.

In response to the outcomes of the OCM, CMMI developed the Enhancing Oncology Model (EOM), which began on July 1, 2023. The EOM aims to address some of the shortcomings of the OCM. Key differences include a focus on high-risk patients, mandatory care management programs, expanded data reporting, and an explicit component on health equity. The EOM has a smaller patient cohort, targeting common tumor types, and requires participating practices to accept downside risk from the outset. It also places a greater emphasis on patient-centered care, with services tailored to the needs of individual patients.

However, the EOM also introduces new challenges. For instance, per beneficiary per month (PBPM) operating payments are significantly reduced compared to OCM, and the risk-sharing arrangements proposed by EOM are not true shared risks between provider and payer, as all the risk resides with the EOM participant. This structure exposes providers to potential financial penalties, which could be a deterrent, especially for smaller, independent practices with limited resources.

The transition from OCM to EOM reflects the ongoing efforts of CMS to evolve its approach to value-based care in oncology, with the aim of improving patient outcomes and reducing costs. However, the complexity of these models and the mixed results so far suggest that achieving these goals is challenging, and the success of the EOM remains to be seen​​​​​​​​.