A Holistic Oncology Care Model

By Pariksith Singh, MD

The last decade has witnessed a sea change in oncologic treatments. Revolutionary treatments, available for various types of cancers, afford patients new treatment options and a new lease of life. Such advances in treatment are remarkable, a continuing testament to the achievements of modern science.

But cancer care is not and can never be just clinical. The new models of Total Oncologic Care (TOC), Oncology Care Model (OCM), Enhancing Oncology Model (EOM), etc. attempt to address the whole complex of the human being who is the patient. OCM means becoming responsible for the total cost of care for the person who is suffering from the disease. Yet OCM also misses out on the multiple domains of human life by being focused mostly on the physical or clinical aspect of cancer.

Based on a literature search on the OCM, this is what we discovered:

The Oncology Care Model (OCM), established by the Centers for Medicare & Medicaid Services (CMS), is an innovative and multi-payer model designed to enhance the quality and coordination of oncology care.

Here are the key points about OCM:

Objective: OCM aims to provide higher quality, more coordinated care for cancer patients undergoing chemotherapy. It focuses on improving health outcomes while managing costs.

Participating Practices: Physician group practices that treat Medicare beneficiaries diagnosed with cancer are part of OCM. These practices commit to using national treatment guidelines and providing enhanced services like care coordination and navigation.

Payment Arrangements: Participating practices enter into payment arrangements that hold them accountable for financial and performance outcomes related to episodes of care surrounding chemotherapy administration.

Whole Practice Transformation: OCM encourages whole practice transformation by aligning financial incentives. This includes performance-based payments to improve care coordination, appropriateness of care, and access for Medicare beneficiaries.

Better Quality, Lower Costs: By incentivizing high-quality, coordinated care, OCM aims to achieve better care, smarter spending, and healthier outcomes for cancer patients.

Duration: OCM is a five-year model that began on July 1, 2016, and ran through June 30, 2021.

Multi-Payer Approach: In addition to CMS, commercial insurers also participate, aligning their oncology payment models with Medicare’s approach.

OCM represents a crucial step toward improving cancer care and setting clear goals for paying providers based on quality rather than quantity of care. It’s part of the broader effort to enhance our nation’s healthcare system."

What is EMO? According to our literature search, this is what we collated:

The Enhancing Oncology Model (EOM) is a five-year voluntary model introduced by the Centers for Medicare & Medicaid Services (CMS). Its primary goal is to transform cancer care, enhance quality, and achieve financial and performance accountability for episodes of care related to systemic chemotherapy administration in cancer patients.

Here are the key points about EOM:

Objective: EOM aims to improve coordination across all healthcare providers involved in a cancer patient’s care. It supports personalized services that help patients navigate and manage their cancer treatment.

Patient-Centered Approach: EOM participants consider patients’ preferences, treatment goals, and health-related social needs (such as housing and transportation assistance). The goal is to provide better support, clearer understanding of diagnosis and prognosis, and adherence to treatment plans.

Support for Underserved Patients: EOM provides additional support for participants treating underserved or lower-income patients, especially those who are dually eligible for Medicare and Medicaid. This aims to improve access, treatment, and outcomes for these beneficiaries.

Alignment with Cancer Moonshot Initiative: EOM aligns with the Cancer Moonshot pillars and priorities, including supporting patients, learning from all patients, targeting personalized treatments, and addressing inequities.

Background: EOM builds upon the Oncology Care Model (OCM), which launched in 2016. OCM focused on enhancing quality and coordination of oncology care while managing costs.

By fostering patient-centered care, EOM contributes to improving the experience of people living with and surviving cancer, supporting President Biden’s Unity Agenda and the Cancer Moonshot initiative.”

We believe that there are other aspects of cancer care that are just as important. The patient is not just a condition or a body but a spectrum of many layers of existence, including the physical, the mental, the vital, the psychological, the psychic, the social, the cultural and the economic. All these need to be addressed. We have called this model Holistic Oncologic Care (HOC). In our view HOC has distinct advantages over TOC when it comes to the overall wellbeing of the patient.

Our approach is a team-based initiative involving not only the medical and radiation oncologists but also the primary care physicians, hospitalists, Skilled Nursing Facility providers, psychologists, dieticians, naturopathic doctors, nutritionists, experts in lifestyle medicine, case managers, nurses, counsellors, palliative care consultants, exercise therapists, support groups, and so on. In short, a team-based approach to oncology. A new kind of environment for healing needs to be offered to the patients and care needs to be individualized, personalized, and customized according to their specific needs.

While standardization of care to the extent possible is needed based on medical evidence, we also need to ensure individuated decision pathways, considering the age and condition of the patient, their ability to tolerate the treatments, and their individual preferences and paradigms. In short, a deeper engagement with each human being is needed.

HOC will utilize these teams to create a unique experience for each patient. We will endeavor not to treat them just as a site for infusion of drugs or the carrier of an affliction that must be targeted, but as a person with feelings, choices, a heart, and mind receptive to healing and wellness. For example, compliant savings below the market rate with better results in morbidity, mortality, patient satisfaction, and most importantly, in quality of life may align incentives for the oncologists away from mere focus on infusion of drugs or treatment of disease to a more open model of patient empowerment and choice. 

The HOC model proposes enhanced shared savings for the Managed Service Organizations and Oncology groups by payers. Radiation Oncology may be capitated to take care of the patients in an entire geographical area while ensuring access, quality of care, compliance, evidence-based medicine and patient safety and engagement.

The model of care will align incentives with the oncologists’ skillsets so that care is based on Fee for Value and not just Fee for Service. With accountability and a holistic approach to care we will create pathways for patients to choose models of integrative and complementary medicine in addition to the current standard operating procedures. Reducing costs in Part A, especially with preventable admissions and transfusions is critical to such an approach.

An academic deliberate approach along with clinical research into such a partnership of patient, providers and health plans will help create a new paradigm that places the patient at the center, with focus on their quality and choice, by empowering and education them about the options available using the best scientific technology and information available. This can be accomplished by a better use of data and analytics and predictive modeling and seeing Oncology as a complex discipline for which protocol-based approaches from a distance might not necessarily work.