Rockville, Md. – In 2020, $200 billion was spent battling cancer. It’s estimated that over 1.8 million individuals will be diagnosed with cancer in 2021 and, since the median age of patients diagnosed with cancer is 66, a substantial portion of the care patients with cancer receive will be covered by Medicare. How can we keep the costs down without reducing the quality of care patients receive? In 2016, the Centers for Medicare & Medicaid Services launched the Oncology Care Model (OCM), an alternative payment model designed to improve the value of care delivered to Medicare beneficiaries with cancer.
An evaluation by Abt Associates, Harvard Medical School, the Lewin Group, and other partners found that, overall, OCM was associated with modest but statistically significant episode payment reductions. More specifically, it was associated with small and significant payment reductions for higher-risk episodes relative to the comparison group (but small and significant relative increases in for lower-risk episodes). The savings did not, however, offset Medicare payments for enhanced oncology services and performance-based payments. Additionally, of 22 measures of utilization, 10 measures of quality, and seven measures of care experiences, only five changed differently over time for OCM versus comparison episodes, meaning the differences in outcomes were minimal. The results of the study were published in the Journal of the American Medical Association.
Abt and our partners—Harvard Medical School, GDIT, The Lewin Group, and Dartmouth Medical Center—assessed the association of OCM with changes in Medicare spending, utilization, quality, and patient experience over the first three years of the model’s implementation. The evaluation compared episodes for Medicare beneficiaries who received care from participating oncology practices with similar patients whose care was provided by carefully matched practices that are not participating. The evaluation is continuing throughout the model’s six-year duration.
OCM had the greatest impact, relative to the comparison group, in reducing episode 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, altering treatment regimens or adoption of costly new treatments, payments for chemotherapy drugs, or hospice care.
“OCM had some impact on higher-risk, high-cost episodes, such as for lung cancer, but this was largely offset by a lack of impact on lower-risk, low-cost episodes, such as for early-stage breast cancer,” said Andrea Hassol, the project director for Abt. “A future model might be more successful by focusing on higher-cost episodes, where there is more potential for financial and quality incentives to make a difference.”
About Abt Associates
Abt Associates is a global consulting and research firm that uses data and bold thinking to improve the quality of people’s lives. From combatting infectious disease and conducting rigorous program evaluations, to ensuring safe drinking water and promoting access to affordable housing—and more—we partner with clients and communities to tackle their most complex challenges. https://www.abtassociates.com