Multiple Myeloma Cost of Care Under the Oncology Care Model: The Influence of High-Cost Therapies

Theroux, Haley Hines; Williams, Alaysia; Liu, Mark; Dahl, Alyssa; Dreyer, Theresa; Horvath, Keith A.; Isola, Luis

doi:10.1200/jop.19.00569

Cited by 10 publications

(15 citation statements)

References 5 publications

(7 reference statements)

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“…This transparency will not only improve current MM care, but it will also ensure that MM care remains affordable and future treatments become available to patients with MM. Therefore, especially in MM, health insurers should prioritise outcome-driven care and facilitate PRO use and shared decision making in clinical practice to ensure that the quality and accessibility of MM treatments are guaranteed [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study

Bennink

Mul

Klift

et al. 2023

Patient

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Section: Discussionmentioning

confidence: 99%

Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study

Bennink

Mul

Klift

et al. 2023

Patient

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“…One study used treatment regimens to predict the cancer stage and found that incorporating this methodology would improve the predictive power of the OCM targets. 10 Other research has focused on the proportion of episodes that are over the target for patients who received guideline-concordant care, concluding that OCM targets do not adequately cover the chemotherapies that are most clinically appropriate for their patients with multiple myeloma 11 and lung 12 and bladder cancers. 13 Research on the Radiation Oncology Model has also found stage to be a critical unmeasured variable.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Addition of Clinical and Staging Data to Improve the Pricing Methodology of the Oncology Care Model

Dreyer

Hamilton²,

Dahl³

et al. 2022

JCO Oncology Practice

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PURPOSE: The Oncology Care Model (OCM) is the largest value-based care model focusing on oncology, but the current pricing methodology excludes relevant data on the cancer stage and current clinical status, limiting the precision of the risk adjustment. METHODS: This analysis evaluated 15,580 episodes of breast cancer, lung cancer, and multiple myeloma, starting between July 1, 2016, and January 1, 2020, with data from a cohort of OCM practices affiliated with academic medical centers. The authors merged clinical data with claims for OCM episodes defined by the Center for Medicare and Medicaid Innovation to identify potential quality improvement opportunities. The regression model evaluated the association of the cancer stage at initial diagnosis and current clinical status with variance to the OCM target price. RESULTS: Cancer stage at the time of initial diagnosis was significant for breast and lung cancers, with stage IV episodes having the highest losses of –$6,700 (USD) for breast cancer ( P < .001) and –$18,470 (USD) for lung cancer ( P < .001). Current clinical status had a significant impact for all three cancers in the analysis, with losses correlated with clinical complexity. Breast cancer and multiple myeloma episodes categorized as recurrent or progressive disease had significantly higher losses than stable episodes, at –$6,755 (USD) for breast ( P < .001) and –$19,448 (USD) for multiple myeloma ( P < .001). Lung cancer episodes categorized as initial diagnosis had significantly fewer losses than stable episodes, at –$3,751 (USD) ( P = .001). CONCLUSION: As the Center for Medicare and Medicaid Innovation designs and launches new oncology-related models, the agency should adopt methodologies that more accurately set target prices, by incorporating relevant clinical data within cancer types to minimize penalizing practices that provide guideline-concordant cancer care.

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“…Some single-practice reports suggested that patients who receive standard of care treatment with novel therapies, including patients with lung cancer treated with immunotherapy, had health care spending that exceeded OCM-defined cost thresholds and could theoretically alter physician prescribing of novel therapies. 8 , 9 However, another study that used broader cohort definitions and ascertained eligibility for novel therapies based solely on diagnosis with a cancer for which a novel therapy is approved found either no association (for chemotherapy for 5 cancers and immunotherapy for 1 cancer) or an association with limited cancer types (for immunotherapy for 2 cancers). 6 The current study used more rigid cohort definitions in identifying patients potentially eligible to receive novel therapies, but because of the smaller sample size, all chemotherapy and immunotherapy novel treatments were combined in 1 analysis, and no statistically significant differences were found in the receipt of novel therapies before and after implementation of the OCM.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although modeling suggested that this adjustment was sufficient to account for the costs of novel therapies, 7 early experiences raised concerns that novel therapies were affecting costs that exceeded OCM spending targets. 8,9 A study found that the OCM was associated with reduced use of expensive supportive care medications. 10 Recently, a large difference-in-differences analysis of cancer care cost and use under the OCM found that the OCM was not associated with the use of novel chemotherapies for 5 cancers in the first 3 years of the OCM, but the study found an increase in the use of immunotherapies for lung cancer and melanoma (2.5 and 2.9 percentage point difference, respectively) but not for kidney cancer.…”

Section: Introductionmentioning

confidence: 99%

Association of Oncologist Participation in Medicare’s Oncology Care Model With Patient Receipt of Novel Cancer Therapies

et al. 2022

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ImportanceMedicare’s Oncology Care Model (OCM) was an alternative payment model that tied performance-based payments to cost and quality goals for participating oncology practices. A major concern about the OCM regarded inclusion of high-cost cancer therapies, which could potentially disincentivize oncologists from prescribing novel therapies.ObjectiveTo examine whether oncologist participation in the OCM changed the likelihood that patients received novel therapies vs alternative treatments.Design, Setting, and ParticipantsThis cohort study of Surveillance, Epidemiology, and End Results (SEER) Program data and Medicare claims compared patient receipt of novel therapies for patients treated by oncologists participating vs not participating in the OCM in the period before (January 2015-June 2016) and after (July 2016-December 2018) OCM initiation. Participants included Medicare fee-for-service beneficiaries in SEER registries who were eligible to receive 1 of 10 novel cancer therapies that received US Food and Drug Administration approval in the 18 months before implementation of the OCM. The study excluded the Hawaii registry because complete data were not available at the time of the data request. Patients in the OCM vs non-OCM groups were matched on novel therapy cohort, outcome time period, and oncologist specialist status. Analysis was conducted between July 2021 and April 2022.ExposuresOncologist participation in the OCM.Main Outcomes and MeasuresPreplanned analyses evaluated patient receipt of 1 of 10 novel therapies vs alternative therapies specific to the patient’s cancer for the overall study sample and for racial subgroups.ResultsThe study included 2839 matched patients (760 in the OCM group and 2079 in the non-OCM group; median [IQR] age, 72.7 [68.3-77.6] years; 1591 women [56.0%]). Among patients in the non-OCM group, 33.2% received novel therapies before and 40.1% received novel therapies after the start of the OCM vs 39.9% and 50.3% of patients in the OCM group (adjusted difference-in-differences, 3.5 percentage points; 95% CI, −3.7 to 10.7 percentage points; P = .34). In subgroup analyses, second-line immunotherapy use in lung cancer was greater among patients in the OCM group vs non-OCM group (adjusted difference-in-differences, 17.4 percentage points; 95% CI, 4.8-30.0 percentage points; P = .007), but no differences were seen in other subgroups. Over the entire study period, patients with oncologists participating in the OCM were more likely to receive novel therapies than those with oncologists who were not participating (odds ratio, 1.47; 95% CI, 1.09-1.97; P = .01).Conclusions and RelevanceThis study found that participation in the OCM was not associated with oncologists’ prescribing novel therapies to Medicare beneficiaries with cancer. These findings suggest that OCM financial incentives did not decrease patient access to novel therapies.

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Multiple Myeloma Cost of Care Under the Oncology Care Model: The Influence of High-Cost Therapies

Cited by 10 publications

References 5 publications

Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study

Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study

Evaluating the Addition of Clinical and Staging Data to Improve the Pricing Methodology of the Oncology Care Model

Association of Oncologist Participation in Medicare’s Oncology Care Model With Patient Receipt of Novel Cancer Therapies

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