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

CME Credits: 1.00

Released: 2021-11-09

Key Points

Question 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?
Findings 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.
Meaning 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.

Abstract

Importance 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.
Objective 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.
Exposures OCM participation.
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.
Results 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.

Educational Objective
To understand the performance of an alternative payment model for Medicare beneficiaries with cancer.

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