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

Nancy L. Keating, MD, MPH, Harvard Medical School, Brigham and Women’s Hospital; Shalini Jhatakia, MA, Amanda S. Tripp, Ph.D., MPH, Inna Cintina, Ph.D., and Carol Simon, Ph.D., The Lewin Group; Gabriel A Brooks, MD, MPH, Geisel School of Medicine; Mary Beth Landrum, Ph.D., Harvard Medical School; Qing Zheng, Ph.D., Thomas J. Christian, Ph.D., Roberta Glass, MPH, and Andrea Hassol, MSPH, Abt Associates; Van Doren Hsu, PharmD, and Colleen M. Kummet, Ph.D., General Dynamics Information Technology; Susannah Woodman, MSW, MPH, Centers for Medicare & Medicaid Innovation

Article

November 9, 2021

In 2016, the 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. Abt and our partners assessed the association of OCM with changes in Medicare spending, utilization, quality, and patient experience over the first three years of model’s implementation.

The evaluation compared episodes for Medicare beneficiaries with fee-for service coverage who received care from participating oncology practices, with similar patients whose care was provided by carefully matched practices that are not participating.  The evaluation found that, overall, OCM was associated with modest but statistically significant episode payment reductions. More specifically, it was associated with small and significant relative episode payment reductions for higher-risk episodes, but small and significant relative increases in for  lower-risk episodes. Additionally, of 22 measures of utilization, 10 measures of quality, and seven measures of care experiences, only five were significantly different between the OCM and comparison episodes/beneficiaries.

OCM had the greatest impacts in reducing payments for non-chemotherapy drugs that are used to manage toxic side effects of chemotherapy (supportive therapy), and in reducing hospitalizations in the last month of life. OCM had no impact in reducing emergency department visits, or on payments for chemotherapy drugs.


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