Association of Participation in the Oncology Care Model With Medicare Payments, Utilization, Care Delivery, and Quality Outcomes
Authors: Nancy L. Keating, Shalini Jhatakia, Gabriel A. Brooks, Amanda S. Tripp, Inna Cintina, Mary Beth Landrum, Qing Zheng, Thomas J. Christian, Roberta Glass, Van Doren Hsu, Colleen M. Kummet, Susannah Woodman, Carol Simon, Andrea Hassol, Giulia Norton, Sean McClellan, Jessie Gerteis, Maria Alice Manetas, Nathan West, Andrew Evans, Mary Juergens, Stephanie Shao, Nirav S. Kapedia, Lauren Riedel, Michael P-H Liu, Robert Wolf, Hajime Uno, Madison Davidson, Rebecca Acanfora, Nwannamaka Ume, David Zhang, Dylan Davis, Anna Braendle, Sehreen Khan, Chai Wong, Sebastian Negrusa
Journal: JAMA (2021)

<h3>Importance</h3> In 2016, the US Centers for Medicare &amp; 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. <h3>Objective</h3> To assess the association of the OCM with changes in Medicare spending, utilization, quality, and patient experience during the OCM's first 3 years. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> OCM participation. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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. <h3>Conclusions and Relevance</h3> 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.