The effect of guideline-concordant novel therapy use on meeting cost targets in OCM: Results from a large community oncology network.

Abstract

6635 Background: The Oncology Care Model (OCM) is intended to incentivize physicians to improve the quality and reduce the cost of cancer care. In OCM, providers are accountable for all costs during six month episodes of care relative to target costs (TC) derived from a baseline spending period (BSP; 2013-2015). This accountability is intended to foster care coordination to reduce preventable emergency department visits and hospitalizations (EDH). Benefits of reducing EDH may be diluted when new treatment indications for costly immunotherapies (IO) are introduced into clinical practice after BSP. Methods: We identified all non-small cell lung cancer (NSCLC) and bladder cancer (BC) OCM episodes attributed to Tennessee Oncology (TO), a large community oncology network of over 90 oncologists, during performance period 2 (PP2; the most recent PP with available data). We selected NSCLC and BC because both diseases have IO indications that became standard of care after BSP. Using claims data analytics software, we identified all NSCLC and BC episodes with spending above TC, and found a subset of these above target episodes (ATEs) without any EDH that remained above TC due to IO use. Two medical oncologists reviewed these cases in duplicate to assess guideline concordance of IO. Results: During PP2 there were 2,623 OCM episodes attributed to TO, including 240 NSCLC and 31 BC episodes. Spending was above TC in 118 (49%) and 13 (42%) of NSCLC and BC episodes, respectively. For these NSCLC and BC ATEs, EDH was prevented in 62 (53%) and 5 (38%) of cases, respectively. In NSCLC and BC ATEs without EDH, 43 (69%) and 5 (100%) of episodes included IO, respectively. Clinician review in duplicate (S.M.S.; C.A.W.) found that the use of IO was NCCN guideline concordant in 33 (77%) and 4 (80%) of these NSCLC and BC cases, respectively (K = 0.87). Conclusions: Guideline-concordant use of expensive IO as its treatment indications expand poses substantial challenges to meeting cost targets in OCM, even when practices prevent EDH. [Table: see text]

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

“… 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. Despite the concerns raised specifically regarding patients with lung cancer treated with immunotherapy, 8 this study found an increase in receipt of novel immunotherapy after the start of the OCM for patients treated by participating clinicians, echoing findings from Keating et al 6 In combination, the results of these 2 studies may reassure patients, clinicians, and policy makers that the OCM does not appear to discourage the use of novel therapies despite incentives to reduce cancer spending.…”

“…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.…”

“…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.…”

“…Although modeling suggested that this adjustment was sufficient to account for the costs of novel therapies, early experiences raised concerns that novel therapies were affecting costs that exceeded OCM spending targets . A study found that the OCM was associated with reduced use of expensive supportive care medications .…”

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

“…A cross-sectional analysis by Parikh et al 16 found that oncologists participating in the OCM varied in their demographic characteristics, care intensity, and exposure to alternative models compared with nonparticipating oncologists in ways that practice-level analyses might meaningfully miss, motivating physician-level analysis. While there is some early suggestive evidence that the OCM altered hospitalization rates 17 and other descriptive or non-peer-reviewed work, 16,[18][19][20][21][22][23][24][25][26][27] there remain few assessments of the OCM's potential effects on care choices. 14 This study evaluates whether OCM participation was associated with clinician behavior within the context of their practices.…”