Factors associated with target price status within the oncology care model population.
Authors: Matthew Molaei, Karen Walsh, Scott W. Keith, Valerie Pracilio Csik, Amy Leader, Vittorio Maio
Journal: Journal of Clinical Oncology (2021)

72 Background: The Oncology Care Model (OCM) is an alternative payment model put forth by the Centers for Medicare and Medicaid Services (CMS), which aims to improve quality of care for cancer beneficiaries, while reducing cost. One of the strategies implemented by CMS to achieve this goal was the development of an episode target price (TP), which uses historical data and episode specific adjusters to calculate a total cost of care goal for each episode. The goal of this analysis was to better understand how CMS risk adjustments could account for episode characteristics, as well as how these characteristics affect likelihood of meeting target price. Methods: OCM performance claims data were abstracted retrospectively from performance periods (PP) 1-6 (episodes initiated from 7/1/2016 – 12/31/2019), in which each episode captured 6 months of care. EHR data was linked to identify cancer staging for OCM Beneficiaries. Any OCM beneficiary with at least one episode in PP 1-6 was included. To assess odds of meeting TP, a logistic regression model with a generalized estimating equation was used to account for patients who contributed multiple episodes. Specific factors evaluated for their association with meeting TP included patient’s age and sex, cancer stage, cancer type, cancer related surgery, clinical trial participation, hospice status, inpatient admissions, observational stays, Medicare part B drug use and radiation therapy. Results: 4,612 episodes were included in analysis, which translated to 2,459 patients, who had an average age of 72 years old and were majority female (50.5%). 2,790 (60.5%) of the episodes met the TP set by OCM. When controlling for covariates, radiation treatment (OR = 1.75, 95%CI: 1.39-2.23), stage 2 compared to stage 4 cancers (OR = 1.86, 95%CI: 1.23-2.80), colorectal cancers (OR = 1.75, 95%CI: 1.11-2.77) and melanomas (OR = 4.35, 95%CI: 2.18-8.67) were significantly associated with increased odds of meeting TP. Novel therapies (OR = 0.19, 95%CI: 0.14-0.26), inpatient admissions (OR = 0.27, 95%CI: 0.22-0.33), observational stays (OR = 0.66, 95%CI: 0.51-0.87) and part B drug use (OR = 0.75, 95%CI: 0.60-0.93) were associated with significantly reduced odds of meeting TP. Conclusions: Our analysis suggests that radiation treatment, as well as selected cancer stage and types may contribute to increased likelihood of meeting TP, which may point to potential areas of cost savings. Conversely, specific resource utilizations such as novel therapy use, inpatient admissions, observational stays, and Medicare part B drug use may decrease the odds of meeting TP, despite being adjusted for in the OCM model. While CMS has recognized that late stage cancers require a more sensitive TP with the metastatic adjustment, other adjustments should also be considered to adequately account for episode characteristics. External validation at other OCM-participating practices is needed to corroborate these results.