Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes | Oncology | JN Learning | AMA Ed Hub [Skip to Content]
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Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes

Educational Objective
To understand the performance of an alternative payment model for Medicare beneficiaries with cancer.
1 Credit CME
Key Points

Question  Was the Centers for Medicare & Medicaid Services Oncology Care Model (OCM), an alternative payment model for cancer patients undergoing chemotherapy, associated with differences in Medicare spending, utilization, quality, and patient experience over the model’s first 3 years?

Findings  In this exploratory difference-in-differences study of Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy (483 310 beneficiaries with 987 332 episodes treated at 201 OCM participating practices and 557 354 beneficiaries with 1 122 597 episodes treated at 534 comparison practices), OCM was associated with a statistically significant relative decrease in total episode payments of $297 that was not sufficient to cover the costs of care coordination or performance-based payments. There were no statistically significant differences in most measures of utilization, quality, or patient experiences.

Meaning  In its first 3 years, the OCM was significantly associated with modestly lower Medicare episode payments that did not offset model payments to participating practices, and there were no significant differences in most utilization, quality, or patient experience outcomes.

Abstract

Importance  In 2016, the US Centers for Medicare & Medicaid Services initiated the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer.

Objective  To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM’s first 3 years.

Design, Setting, and Participants  Exploratory difference-in-differences study comparing care during 6-month chemotherapy episodes in OCM participating practices and propensity-matched comparison practices initiated before (January 2014 through June 2015) and after (July 2016 through December 2018) the start of the OCM. Participants included Medicare fee-for-service beneficiaries with cancer treated at these practices through June 2019.

Exposures  OCM participation.

Main Outcomes and Measures  Total episode payments (Medicare spending for Parts A, B, and D, not including monthly payments for enhanced oncology services); utilization and payments for hospitalizations, emergency department (ED) visits, office visits, chemotherapy, supportive care, and imaging; quality (chemotherapy-associated hospitalizations and ED visits, timely chemotherapy, end-of-life care, and survival); and patient experiences.

Results  Among Medicare fee-for-service beneficiaries with cancer undergoing chemotherapy, 483 319 beneficiaries (mean age, 73.0 [SD, 8.7] years; 60.1% women; 987 332 episodes) were treated at 201 OCM participating practices, and 557 354 beneficiaries (mean age, 72.9 [SD, 9.0] years; 57.4% women; 1 122 597 episodes) were treated at 534 comparison practices. From the baseline period, total episode payments increased from $28 681 for OCM episodes and $28 421 for comparison episodes to $33 211 for OCM episodes and $33 249 for comparison episodes during the intervention period (difference in differences, −$297; 90% CI, −$504 to −$91), less than the mean $704 Monthly Enhanced Oncology Services payments. Relative decreases in total episode payments were primarily for Part B nonchemotherapy drug payments (difference in differences, −$145; 90% CI, −$218 to −$72), especially supportive care drugs (difference in differences, −$150; 90% CI, −$216 to −$84). The OCM was associated with statistically significant relative reductions in total episode payments among higher-risk episodes (difference in differences, −$503; 90% CI, −$802 to −$204) and statistically significant relative increases in total episode payments among lower-risk episodes (difference in differences, $151; 90% CI, $39-$264). The OCM was not significantly associated with differences in hospitalizations, ED visits, or survival. Of 22 measures of utilization, 10 measures of quality, and 7 measures of care experiences, only 5 were significantly different.

Conclusions and Relevance  In this exploratory analysis, the OCM was significantly associated with modest payment reductions during 6-month episodes for Medicare beneficiaries receiving chemotherapy for cancer in the first 3 years of the OCM that did not offset the monthly payments for enhanced oncology services. There were no statistically significant differences for most utilization, quality, and patient experience outcomes.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (keating@hcp.med.harvard.edu).

Accepted for Publication: September 17, 2021.

Author Contributions: Mss Jhatakia and Hassol had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Keating and Ms Jhatakia are co–first authors. Dr Simon and Ms Hassol are co–senior authors.

Concept and design: Keating, Jhatakia, Brooks, Landrum, Kummet, Woodman, Simon, Hassol.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Keating, Jhatakia, Brooks, Cintina, Kummet, Simon, Hassol.

Critical revision of the manuscript for important intellectual content: Keating, Jhatakia, Brooks, Tripp, Landrum, Zheng, Christian, Glass, Hsu, Kummet, Woodman, Simon, Hassol.

Statistical analysis: Keating, Jhatakia, Tripp, Cintina, Landrum, Zheng, Christian, Glass, Kummet, Simon.

Obtained funding: Keating, Simon, Hassol.

Administrative, technical, or material support: Keating, Jhatakia, Hsu, Simon, Hassol.

Supervision: Keating, Jhatakia, Woodman, Simon, Hassol.

Conflict of Interest Disclosures: Dr Brooks reported receiving personal fees from Ipsen Biopharmaceuticals and UnitedHealthcare and payments to his institution for clinical trials from Taiho Pharmaceuticals, Hoffmann-La Roche, and Incyte Corporation. Ms Glass reported being employed by Abt Associates, the firm hired by the Centers for Medicare & Medicaid Services to evaluate the Oncology Care Model. Dr Simon reported being employed by UnitedHealth Group. Ms Hassol reported a contract with the Centers for Medicare & Medicaid Services outside the submitted work. No other disclosures were reported.

Funding/Support: The authors are members of an evaluation team contracted by the Centers for Medicare & Medicaid Services to evaluate the Oncology Care Model. The analyses on which this publication is based were performed under contract HHSM-500-2014-00026I sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services.

Role of the Funder/Sponsor: The sponsor contributed to the design and conduct of the study; collection, management, analysis, and interpretation of the data; review and approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The members of the Oncology Care Model Evaluation Team are listed in Supplement 2.

Meeting Presentation: This work was presented on June 17, 2021, at the AcademyHealth Annual Research Meeting (virtual meeting).

References
1.
Siegel  RL , Miller  KD , Fuchs  HE , Jemal  A .  Cancer Statistics, 2021.   CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654PubMedGoogle ScholarCrossref
2.
National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer stat facts: cancer of any site. Accessed February 26, 2021. https://seer.cancer.gov/statfacts/html/all.html
3.
Mariotto  AB , Enewold  L , Zhao  J , Zeruto  CA , Yabroff  KR .  Medical care costs associated with cancer survivorship in the United States.   Cancer Epidemiol Biomarkers Prev. 2020;29(7):1304-1312. doi:10.1158/1055-9965.EPI-19-1534PubMedGoogle ScholarCrossref
4.
Brooks  GA , Li  L , Uno  H , Hassett  MJ , Landon  BE , Schrag  D .  Acute hospital care is the chief driver of regional spending variation in Medicare patients with advanced cancer.   Health Aff (Millwood). 2014;33(10):1793-1800. doi:10.1377/hlthaff.2014.0280PubMedGoogle ScholarCrossref
5.
Bach  PB . Monthly and median costs of cancer drugs at the time of FDA approval, 1965-2019. Center for Health Policy & Outcomes, Memorial Sloan Kettering Cancer Center. Accessed March 31, 2021. https://www.mskcc.org/research-areas/programs-centers/health-policy-outcomes/cost-drugs
6.
ASCO Post Staff. HHS announces physician groups selected for initiative promoting better cancer care. Published July 26, 2016. Accessed February 26, 2021. https://ascopost.com/issues/july-25-2016/hhs-announces-physician-groups-selected-for-initiative-promoting-better-cancer-care/
7.
Center for Medicare & Medicaid Innovation. Oncology Care Model. Accessed February 26, 2021. https://innovation.cms.gov/innovation-models/oncology-care
8.
Kline  RM , Muldoon  LD , Schumacher  HK ,  et al.  Design challenges of an episode-based payment model in oncology: the Centers for Medicare & Medicaid Services Oncology Care Model.   J Oncol Pract. 2017;13(7):e632-e645. doi:10.1200/JOP.2016.015834PubMedGoogle ScholarCrossref
9.
Welch  WP , Bindman  AB .  Town and gown differences among the 100 largest medical groups in the United States.   Acad Med. 2016;91(7):1007-1014. doi:10.1097/ACM.0000000000001240PubMedGoogle ScholarCrossref
10.
Keating  NL , Huskamp  HA , Schrag  D ,  et al.  Diffusion of bevacizumab across oncology practices: an observational study.   Med Care. 2018;56(1):69-77. doi:10.1097/MLR.0000000000000840PubMedGoogle ScholarCrossref
11.
Centers for Medicare & Medicaid Services. OCM Performance-Based Payment Methodology. Version 6.0. Published February 2020. Accessed February 26, 2021. https://innovation.cms.gov/files/x/ocm-pp3beyond-pymmeth.pdf
12.
Oncology Care Model Evaluation Team. First Annual Report From the Evaluation of the Oncology Care Model: Baseline Period. Published February 1, 2018. Accessed February 26, 2021. https://downloads.cms.gov/files/cmmi/ocm-baselinereport.pdf
13.
Centers for Medicare & Medicaid Services. CMS Measures Inventory Tool: admissions and emergency department (ED) visits for patients receiving outpatient chemotherapy. Accessed February 26, 2021. https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=2929
14.
American Society of Clinical Oncology Quality Oncology Practice Initiative. QOPI 2021 reporting tracks. Accessed February 26, 2021. https://practice.asco.org/sites/default/files/drupalfiles/QOPI-2021-Round-1-Reporting-Tracks-Public-Posting.pdf
15.
National Quality Forum. Measuring performance. Accessed February 26, 2021. https://www.qualityforum.org/Measuring_Performance/Measuring_Performance.aspx
16.
Pak  K , Uno  H , Kim  DH ,  et al.  Interpretability of cancer clinical trial results using restricted mean survival time as an alternative to the hazard ratio.   JAMA Oncol. 2017;3(12):1692-1696. doi:10.1001/jamaoncol.2017.2797PubMedGoogle ScholarCrossref
17.
Agency for Healthcare Research and Quality. CAHPS Cancer Care Survey. Accessed May 28, 2021. https://www.ahrq.gov/cahps/surveys-guidance/cancer/index.html
18.
Dimick  JB , Ryan  AM .  Methods for evaluating changes in health care policy: the difference-in-differences approach.   JAMA. 2014;312(22):2401-2402. doi:10.1001/jama.2014.16153PubMedGoogle ScholarCrossref
19.
Oncology Care Model Evaluation Team. Evaluation of the Oncology Care Model: performance periods 1-5. Published January 2021. Accessed February 26, 2021. https://innovation.cms.gov/data-and-reports/2021/ocm-evaluation-pp1-5
20.
Center for Medicare & Medicaid Innovation. Oncology Care First model: informal request for information. Accessed February 26, 2021. https://innovation.cms.gov/files/x/ocf-informalrfi.pdf
21.
Aviki  EM , Schleicher  SM , Mullangi  S , Matsoukas  K , Korenstein  D .  Alternative payment and care-delivery models in oncology: a systematic review.   Cancer. 2018;124(16):3293-3306. doi:10.1002/cncr.31367PubMedGoogle ScholarCrossref
22.
Newcomer  LN , Gould  B , Page  RD , Donelan  SA , Perkins  M .  Changing physician incentives for affordable, quality cancer care: results of an episode payment model.   J Oncol Pract. 2014;10(5):322-326. doi:10.1200/JOP.2014.001488PubMedGoogle ScholarCrossref
23.
Colla  CH , Lewis  VA , Gottlieb  DJ , Fisher  ES .  Cancer spending and accountable care organizations: evidence from the Physician Group Practice Demonstration.   Healthc (Amst). 2013;1(3-4):100-107. doi:10.1016/j.hjdsi.2013.05.005PubMedGoogle ScholarCrossref
24.
Lam  MB , Figueroa  JF , Zheng  J , Orav  EJ , Jha  AK .  Spending among patients with cancer in the first 2 years of accountable care organization participation.   J Clin Oncol. 2018;36(29):2955-2960. doi:10.1200/JCO.18.00270PubMedGoogle ScholarCrossref
25.
Lam  MB , Zheng  J , Orav  EJ , Jha  AK .  Early accountable care organization results in end-of-life spending among cancer patients.   J Natl Cancer Inst. 2019;111(12):1307-1313. doi:10.1093/jnci/djz033PubMedGoogle ScholarCrossref
26.
Kim  H , Keating  NL , Perloff  JN , Hodgkin  D , Liu  X , Bishop  CE .  Aggressive care near the end of life for cancer patients in Medicare accountable care organizations.   J Am Geriatr Soc. 2019;67(5):961-968. doi:10.1111/jgs.15914PubMedGoogle ScholarCrossref
27.
Herrel  LA , Norton  EC , Hawken  SR , Ye  Z , Hollenbeck  BK , Miller  DC .  Early impact of Medicare accountable care organizations on cancer surgery outcomes.   Cancer. 2016;122(17):2739-2746. doi:10.1002/cncr.30111PubMedGoogle ScholarCrossref
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