Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes

Abstract

Key PointsQuestionWas 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?FindingsIn 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.MeaningIn 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.

Impact of the Oncology Care Model on Use of Supportive Care Medications During Cancer Treatment

“…We used claims and administrative data for Medicare beneficiaries with traditional fee-for-service coverage who initiated systemic therapy for cancer during 2014-2019 and met additional eligibility criteria described elsewhere. 12,13 We evaluated care delivery during 6-month treatment episodes initiated by systemic anticancer therapy paid for by Medicare Part B or Part D. 14…”

“…The propensity score model accounted for episode, practice, and market-level characteristics; details of the comparison group selection are described elsewhere. 12,13,15 We studied the use of supportive care medications in the baseline period (6-month episodes starting from July 2, 2014, through January 1, 2016, and ending by June 30, 2016) and the intervention period (6-month episodes starting from July 1, 2016, through January 1, 2019, and ending by June 30, 2019).…”

“…The impacts of OCM on cancer treatment and Medicare spending are beginning to take shape. 12,13 Here, we describe clinical impacts of OCM on use of supportive care medications during the first three years of OCM, with attention to clinically relevant patient subgroups.…”

Oncologist Peer Comparisons as a Behavioral Science Strategy to Improve Hospice Utilization

“…37 These efforts represent a good first step; however, recent data exploring impact of the Oncology Care Model did not show any improvement in hospice enrollment or timing. 38 Perhaps, this can be explained by the fact that multisite practices, academic oncologists, and For referral, enrollment, and short stay in hospice, estimates are odds ratios and 95% CIs for differences in hospice outcomes between study arms from logistic regression models estimated with GEE and an exchangeable correlation structure, clustering on oncologist. Models also adjust for randomization stratification factor (oncologist specialty: heme malignancy or solid tumor).…”

Hospice-Palliative Medicine as a Model of Value-Based Healthcare

“…In the United States, the Centers for Medicare and Medicaid Services adopted VBHC to treat cancer patients in 2016 and attempted to provide higher quality service through more coordinated cancer care. 5 Since 2017, the NHS has also been funding a pilot project on the “Vanguards” care model that integrates various medical resources, including the primary care system, acute care system, community, and home care. 6 A typical example of VBHC is the improvement of side-effect-induced patient safety issues and conservation of healthcare resources through the reduction of instances where frail older patients are overmedicated due to being given multiple prescriptions.…”