Impact of the Oncology Care Model on use of bone supportive medications, antiemetics, and growth factors.
Authors: Brooks Gabriel A. , Landrum Mary Beth , Kapadia Nirav S. , Liu Pang-Hsiang , Wolf Robert R , Riedel Lauren E , Hsu Van Doren , Jhatakia Shalini , Simon Carol , Hassol Andrea , Keating Nancy Lynn 
Published: June 2021

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Background: The Oncology Care Model (OCM) is a voluntary, episode-based alternative payment model for cancer care launched by the Centers for Medicare & Medicaid Services in July 2016. OCM incentivizes participating practices to reduce spending during chemotherapy treatment while maintaining quality of care. We evaluated the impact of OCM on the use of costly supportive care medications. Methods: Using 100% Medicare claims (2013-2019), we evaluated use of outpatient supportive care medications during chemotherapy episodes assigned to OCM practices (n = 186) or propensity-matched comparison practices (n = 534). For bone supportive medications, we evaluated use of bisphosphonates and/or denosumab in beneficiaries with bone metastases from breast, lung, or prostate cancer. For anti-emetic drugs, we evaluated prophylactic use of neurokinin-1 (NK1) antagonists and long-acting (LA) serotonin antagonists. For white blood cell growth factors (GCSFs), we evaluated prophylactic use in beneficiaries starting chemotherapy for breast, lung, or colorectal cancer; we separately evaluated use of biosimilar (vs originator) filgrastim. Analyses employed the difference-in-differences (DID) approach, excepting the filgrastim biosimilar analysis where we assessed the adoption trend. Results: There was no OCM impact on receipt of any bone supportive medication (denosumab or bisphosphonate) among beneficiaries with bone metastases; however, OCM led to a relative decrease in use of denosumab for breast cancer (DID = -5.0 percentage points [90% CI -7.1, -2.8]), prostate cancer (-4.0 percentage points [90% CI -5.9, -2.2]), and lung cancer (-4.1 percentage points [90% CI -7.4, -0.9]). In beneficiaries starting chemotherapy regimens with high or moderate emetic risk, OCM led to reductions in prophylactic use of NK1 antagonists and LA serotonin antagonists (e.g. 6.0 percentage point reduction in use of NK1 antagonists during high emetic risk chemotherapy [90% CI -9.0, -3.1]); there was no impact on antiemetic use during low emetic risk chemotherapy. There was no OCM impact on use of prophylactic WBC growth factors among beneficiaries receiving chemotherapy with high risk for febrile neutropenia (FN). Among beneficiaries receiving chemotherapy with intermediate risk for FN, OCM led to a 7.6 percentage point reduction in prophylactic GCSF use for patients with breast cancer (90% CI -12.6, -2.7); however, there was no OCM impact on prophylactic GCSF use in patients with lung or colorectal cancer. Among beneficiaries receiving filgrastim, OCM led to faster adoption of biosimilar vs. originator filgrastim (differential trend estimate 2.6%, 90% CI 1.0, 4.4). Conclusions: OCM led to reduced use of some high cost supportive care medications, with patterns suggesting more value-conscious care. Alternative payment models have potential to drive value-based changes in medication use during cancer care.