Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model

Abstract

IMPORTANCE Health insurers reimburse clinicians in many ways, including the ubiquitous fee-forservice model and the emergent shared-savings models. Evidence on the effects of these emergent models in oncological treatment remains limited. OBJECTIVES To analyze the early use and cost associations of a recent Medicare payment program, the Oncology Care Model (OCM), which included a shared savings-like component. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled study used a difference-indifferences approach on 2 years of data, from July 1, 2015, to June 30, 2017-1 year before and 1 year after launch of the OCM-to compare the differences between participating and nonparticipating practices, controlling for patient, clinician, and practice factors. Participation in the OCM began on July 1, 2016. Associations of participation with care use and cost were estimated for care directly managed by clinicians from a large network within their Medicare populations for breast, lung, colon, and prostate cancers. Data were analyzed from September 2019 to March 2020. EXPOSURES Participating practices were paid a monthly management fee of $160 per beneficiary and a potential risk-adjusted performance-based payment for eligible patients who received chemotherapy treatment, in addition to standard fee-for-service payments. MAIN OUTCOMES AND MEASURES Office visits, drug administrations, patient hydrations, drug costs, and total costs. RESULTS Monthly means data at the physician-level were evaluated for 11 869 physician-months for breast cancers, 11 135 physician-months for lung cancers, 8592 physician-months for colon cancers, and 9045 physician-months for prostate cancers. Patients at OCM practices had a mean (SD) age of 63.4 (3.1) years, and a mean (SD) of 59% (7 percentage points) of their patients were women.

Economic Analysis on Adoption of Biosimilar Granulocyte Colony-Stimulating Factors in Patients With Nonmyeloid Cancer at Risk of Febrile Neutropenia Within the Oncology Care Model Framework

“…[31][32][33][34][35] Biosimilar G-CSF offers the same benefit as its reference at a lower cost, which is an opportunity to reduce lower-value care. 36 Furthermore, reinvesting some of these savings to treat additional patients may lead to improved overall population outcomes, meeting key criteria of the OCM key metrics. In fact, when reviewing data from 2014 to 2018, CMS has found more than a 50% increase in biosimilar filgrastim utilization in OCM-participating practices.…”

Integrating Academic and Community Cancer Care and Research through Multidisciplinary Oncology Pathways for Value-Based Care: A Review and the City of Hope Experience

“…This VRP group developed a Value Framework (VF) with specific projects identified under each of the three pillars of evidence-based care, care management, and care after cancer, as shown in Figure 1 . These pillars are derived from the key components identified in the medical oncology home and OCM models as well as several value-based payer initiatives which have shown value [ 6 , 7 , 8 , 11 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. A full discussion of our value-based care initiative is beyond the scope of this paper; however, we present our value framework and highlights of several other key projects within the framework to show the interdependence of those projects in advancing the implementation and evolving outcome analytics of multidisciplinary oncology pathways.…”

“…Oncology pathways are a major component of these programs, with studies of implemented pathway programs showing equal or improved outcomes with lower costs in medical oncology [ 12 , 13 , 14 , 15 , 16 , 17 ], as well as in other disciplines including surgery, radiation oncology, supportive care, and end of life [ 18 , 19 , 20 , 21 , 22 , 23 ]. The evaluation and adoption of oncology pathways were further stimulated by Center for Medicare and Medicaid Services (CMS)’s oncology care MIPPs and Oncology Care Model (OCM) alternate payment programs and private payer pilots with academic and community-based networks and various private payors [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Secret Sauce—How Diverse Practices Succeed in Centers for Medicare & Medicaid Services Oncology Care Model

“…Drug costs can comprise up to 70% of episode costs; thus, drug utilization is an important target for improvement activities. [9][10][11] Failure to control drug costs may financially overshadow other improvement activities (Table 3).…”