Navigating the Enhanced Oncology Model: Insights and Strategies From American Oncology Network

American Oncology Network (AON) was an early adopter of the Enhanced Oncology Model (EOM), announcing its participation in July 2023. In an interview with Pharmacy Times^®, Melody Chang, RPh, MBA, BCOP, vice president of pharmacy operations at AON, explains how AON was able to build on its experience with the Oncology Care Model (OCM) when adopting the EOM. However, Chang shares that the EOM adoption process posed unique challenges, including the presence of limited predictive models, various unknown benchmarks, and the need to align workflows with new program priorities, such as social determinants of health (SDOH).

A patient undergoes intravenous therapy. Image Credit: © Heisenberg - stock.adobe.com

Chang explains that participation in EOM has led to adjustments in patient care workflows, particularly in aligning treatments with program guidelines post-attribution. The pharmacy team plays a vital role in this process, ensuring evidence-based, cost-effective care, while managing adverse effects (AEs) and optimizing quality reporting. Improved EMR documentation and partnerships with external organizations also helped to streamline care coordination and reporting.

Pharmacy Times: What challenges has AON faced as an early adopter of the EOM model?

Melody Chang, RPh, MBA, BCOP: Since AON participated in the OCM in the past, we came into the EOM with a strong foundation. However, even with that experience, being an early adopter of EOM has presented its own unique challenges.

One significant challenge has been the lack of reliable predictive models early on. Traditional models often struggled due to limited population data and short time periods, making it difficult to predict financial outcomes with confidence. Without robust predictive tools, we faced greater uncertainty in estimating our financial risks and potential savings under the EOM model.

Another hurdle was dealing with unknown benchmark data at the time of enrollment. Without clear benchmarks or saving targets upfront, it was challenging to prepare effectively or align our strategies to meet performance expectations. This uncertainty added pressure, particularly as we move into a mandatory downside risk structure, where financial penalties become a real possibility.

We also had to adapt to new program priorities, like tracking SDOH and equity-related metrics, which required some upgrades to our systems and workflows. Additionally, the opportunity cost of lower [Monthly Enhanced Oncology Services (MEOS)] payment during the initial phases of EOM created financial strain. The [MEOS] payments are essential for funding care coordination and the infrastructure needed to meet EOM requirements, so starting with reduced support made it more difficult to scale up and implement changes across our large network of clinics.

Despite these challenges, we've leaned on our experience with OCM to navigate this transition and learn along the way. EOM has given us the opportunity to be leaders in value-based care, and while it hasn't been easy, every challenge has helped us refine our approach and it improve the care we deliver to our patients.

Pharmacy Times: How has participation in the EOM impacted patient care workflows for the 7 included disease states?

Chang: Participating in the EOM has brought meaningful changes to our workflows, but one of the most difficult aspects has been managing the backend regimen changes and adjustments that come after a patient is confirmed as a part of the program. Attribution isn’t immediate, meaning that while patients may already be receiving care, it often takes time to confirm their inclusion in the EOM based on program criteria. Once that confirmation happens, we sometimes need to revisit the treatments they are already on to ensure they aligned with EOM guidelines for cost effectiveness, evidence-based care, and other program requirements. This reassessment can involve changes to medications, supportive care protocols, or even how we manage [AEs]. These adjustments, while necessary, can be both time consuming and complex, especially across a large network like AON.

On the supportive care and reporting side, we partner with Thyme Care and organizations specializing in care coordination and data-driven solutions. They have been instrumental in streamlining processes and ensuring compliance with EOM’s detailed reporting requirements. This partnership frees up our team to focus more on direct patient care, helping us maintain high quality interactions with patients.

Overall, EOM has pushed us to be more proactive and data driven. However, the complexity of making adjustments post-attribution remains a key area of focus for us. With the help of tools and a partnership [with] Thyme Care, we've been able to adapt, ensuring that patients continue to receive high quality, value-based care, while meeting the program's evolving requirements.

Pharmacy Times: What role does the pharmacy team play in optimizing care under the EOM model?

Chang: The pharmacy team plays a critical role in making the EOM model work. One of their main responsibilities is ensuring that treatment regimens aligned with the EOM's focus on evidence-based care and cost effectiveness, and they are also at the forefront of managing treatment-related [AEs]. If a patient is struggling with toxicity or adherence issues, the pharmacy team steps in to provide solutions, whether that's adjusting the medication or offering supportive therapies.

Education is another key area. Pharmacists spend a lot of time counseling patients, especially those on oral therapies, to ensure they understand how to take their medications and what to watch for in terms of [AEs]. Lastly, the team contributes to quality reporting by meticulously documenting interventions and outcomes, which directly impact how we measure success under EOM.

Pharmacy Times: How has AON's pharmacy team adapted workflows to align with EOM requirements?

Chang: Our pharmacy team has focused on 2 key areas to align with the EOM requirements. First, we have leveraged our technology by adding a flag in our EMR system making it easier to identify patients eligible for EOM pathways. Second, the pharmacy team ensures that all treatment protocols follow EOM guidelines focusing on therapies that are both clinically effective and cost efficient. By doing this, we not only meet the program's requirements, but also ensure that patients receive high quality of care.

Pharmacy Times: Are there any significant changes in the use of oral vs IV therapies driven by the EOM model?

Chang: We haven't seen a significant shift from oral to IV therapies directly driven by EOM. Both oral and IV therapies remain essential in oncology care, with the choice largely depending on the clinical needs of the patient and the specific disease state.

However, we are closely monitoring potential changes due to the Inflation Reduction Act (IRA). One key provision of the IRA is the cap on out-of-pocket cost for Medicare Part D beneficiaries, which could make oral therapies more accessible and affordable for some patients. As these changes take effect, they might influence treatment decisions, particularly for patients who previously faced financial barriers to oral therapies. While EOM itself hasn't driven this shift, we anticipate that the IRA could play a role in shaping how oral and IV therapies are utilized in the future. Our team is prepared to adapt to this development to ensure patients continue to receive the best possible care.

Pharmacy Times: What improvements or enhancements have been made in EMR documentation to meet EOM standards?

Chang: Fortunately, AON was already meeting many of the documentation standards required by EOM because of a previous experience with OCM and other value-based care programs. Our partnership with time care makes it easier to manage patient navigation activities, like creating care plans and addressing social determinants of health. All this information is now documented in our EMR, giving the entire care team access to ensure seamless patient-centered care, while meeting the enhanced standards of EOM.

Pharmacy Times: How does improved documentation in the EMR contribute to quality reporting and patient outcomes?

Chang: The enhancements we've made to our EMR documentation directly support quality reporting and the better patient outcomes. By capturing data accurately and consistently, we can track performance metrics more effectively and make informed decisions.

We've also been able to close any gaps in documentation, ensuring nothing gets overlooked. This thorough documentation enables our care teams to act quickly and confidently, leading to timely interventions and improved patient care. Ultimately, it's about using data not just to meet program requirements, but to truly enhance the quality of care we provide.

Pharmacy Times: What lessons learned as an early adopter of EOM can be shared with other oncology groups considering participation?

Chang: One of the key lessons we've learned is that having preexisting infrastructure, whether from participation in OCM or other value-based care programs, can significantly soften the financial and operational burden of participating in EOM. Practices with established workflow, data systems, and care coordination processes are better positioned to meet EOM requirements without incurring excessive [full-time equivalent] related expenses.

Another important takeaway is the need for robust predictive models to effectively manage both the downside risk and upside share savings practices, should either partner with organizations that specialize in modeling financial outcomes or building their own predictive tools. These models are essential for estimating performance and planning strategically, especially in programs where financial risk is mandatory.

Finally, we've recognized that the reinsurance market for risk coverage is still in its early stage. While it isn't fully developed, practices should evaluate available options as a part of their risk management strategy. Having some form of coverage in place can provide additional security as practices navigate the uncertainties of value-based care. Overall, preparation and strategic planning are critical for success in EOM, leveraging existing infrastructure, investing in predictive analytics, and exploring risk mitigation strategies can help practices confidently take on the challenges of value-based care.

Pharmacy Times: What future strategies does AON envision for expanding or refining its approach under the EOM model?

Chang: As we look ahead, we're really interested in how the [IRA] might create new opportunities, especially if drug prices come down significantly. This could have a big impact on cost dynamics and how we balance quality care with program goals. We're keeping a close eye on these changes to see how they might shape our strategies.

We will also explore opportunities to expand into other value-based care models beyond EOM. Ultimately, our goal is to take what we have learned from EOM and apply it to new initiatives, scaling our efforts to deliver even greater value and better outcomes for our patients.