Evaluation of Practice Patterns Among Oncologists Participating in the Oncology Care Model
Authors: Brigham Walker, Jennifer Frytak, Jad Hayes, Marcus Neubauer, Nicholas Robert, Lalan Wilfong
Journal: JAMA Network Open (2020)

<h3>Importance</h3> Health insurers reimburse clinicians in many ways, including the ubiquitous fee-for-service model and the emergent shared-savings models. Evidence on the effects of these emergent models in oncological treatment remains limited. <h3>Objectives</h3> 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. <h3>Design, Setting, and Participants</h3> This nonrandomized controlled study used a difference-in-differences 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. <h3>Exposures</h3> 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. <h3>Main Outcomes and Measures</h3> Office visits, drug administrations, patient hydrations, drug costs, and total costs. <h3>Results</h3> 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. Participation in the OCM was associated with less physician-administered prostate cancer drug use (difference, 0.29 [95% CI, –0.47 to –0.11] percentage points, or 24.0%) translating to a mean of $706 (95% CI, –$1383 to –$29) less in drug costs per month. Monthly drug costs were also lower, at $558 (95% CI, –$1173 to $58) less for treatment for lung cancer. Total costs were lower by 9.7% or $233 (95% CI, –$495 to $30) for breast cancer, 9.9% or $337 (95% CI, –$618 to –$55) for lung cancer, 14.2% or $385 (95% CI, –$780 to $10) for colon cancer, and 29.2% or $610 (95% CI, –$1095 to –$125) for prostate cancer; however, these differences were largely offset by program costs. Clinician visits were also lower by 11.2% or 0.11 (95% CI, –0.20 to –0.01) percentage points among patients with breast cancer and by 14.4% or 0.19 (95% CI, –0.37 to –0.02) among patients with colon cancer. <h3>Conclusions and Relevance</h3> These findings suggest that payment models with shared-savings components can be associated with fewer visits and lower costs in certain cancer settings in the first year, but the savings can be modest given the costs of program administration.