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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?
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.
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.
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.
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.
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.
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.
Corresponding Author: Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115 (email@example.com).
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).
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