How CMS's Enhancing Oncology Model advances health equity in cancer care: Fireside chat with Dr. Dora Hughes

The CMS Innovation Center is preparing to upgrade its value-based Oncology Care Model (OCM) to the Enhancing Oncology Model (EOM), where the core requirements will be to capture data on social determinants of health (SDoH). As cancer centers gear up to participate, how well they fulfill this requirement will be key to their success.



During an October Becker's Hospital Review webinar sponsored by Flatiron Health, James Hamrick, MD, vice president of clinical oncology at Flatiron Health, moderated a fireside chat with Dora Hughes, MD, chief medical officer at the CMS Innovation Center, about the multifaceted approach CMS is taking to addressing health equity. 

Four key takeaways were:

1. CMS is committed to moving the needle on health equity. Health equity is a shared goal for healthcare providers, health technology innovators and EHR vendors. The issue is often invoked in Congress as legislators debate healthcare policy changes; at the federal level, CMS is one of its staunchest advocates. 

Dr. Hughes's work has focused on health equity for years. She was tapped to join CMS last year: "They wanted a chief medical officer that would fulfill the traditional roles of providing clinical input and liaising with the provider community — but they also wanted someone that could hit the ground running on health equity."

Dr. Hughes recalled how President Biden's administration bolstered CMS's resolve to advance health equity. "Everyone was asking: What can we do through our programs, models and initiatives to close gaps in access and quality of care?" She pointed out that CMS is currently overseeing 28 care models that focus on health equity, with many more in the pipeline.

2. One of CMS's top health equity priorities is strengthening data collection and analysis. The other priorities are: 

    • Embedding health equity by adapting care delivery requirements, payment adjustments and quality measurements.
    • Diversifying the beneficiary base of value-based care models by collaborating more closely with safety net providers.
    • Evaluating the impact of CMS's programs and initiatives on health equity.

Improving data collection supports these priorities by monitoring and evaluating care delivery models and informing improvements. "The data is the linchpin for our long-term success," Dr. Hughes said.

3. Health equity-related improvements in cancer care are a special concern. Reflecting its heightened focus on health equity, CMS will require oncology care providers that join EOM to develop health equity plans that address questions such as: What patient populations are you serving? What are the disparities present in those populations? What are the interventions you could support to address those disparities? 

"We want to learn what you're learning as you're caring for those patients," Dr. Hughes said. To compensate providers for those efforts, CMS will remit higher Monthly Enhanced Oncology Services (MEOS) payments and higher additional payments for low-income, dual-eligible beneficiaries, who often need high-touch navigation to wraparound social services.

4. Having standardized protocols and being mindful of implicit bias are ways providers can reduce variation that leads to poor outcomes. Beyond SDoH data collection and other efforts specifically focused on health equity, merely having well-defined clinical pathways aligned with the standard of care can also reduce disparities. CMS is also working on developing race-adjusted clinical decision-support tools to reduce the possibility of introducing implicit bias, which can contribute to exacerbating inequities. "Taking care that new technology and innovation do not worsen inequities is one of these things you have to be mindful of even with EOM," Dr. Hamrick concluded.


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