Amid increasing interest in controlling health care spending and improving quality of care, the Centers for Medicare and Medicaid Services (CMS) have been testing new payment models that increase accountability of providers for the quality and costs of care that they deliver.
In a study published in JAMA, Open, professor of health care policy Nancy L. Keating MD, MPH, professor of health care policy Mary Beth Landrum PhD, and partners at Abt Associates, The Lewin Group, Geisel School of Medicine at Dartmouth, and GDIT assess the impact of the CMS Oncology Care Model (OCM) on spending, utilization, quality, and outcomes for more than
OCM is a voluntary alternative payment model for patients receiving systemic cancer therapy (chemotherapy, targeted therapy, immunotherapy, or hormonal therapy) with a goal of improving care at same or lower cost. Since July 2016, 201 practices with more than 3200 oncologists have provided care for more than 500,000 beneficiaries treated during more than 1 million 6-month episodes. Practices participating in OCM may bill $160 per patient per month for delivering enhanced oncology services and they earn performance-based payments if they meet spending and quality goals. Practices must provide care coordination, patient navigation, care plans and care plans to help patients understand their cancer and its treatment. Practices could participate in 1- or 2-sided risk; all elected 1-sided risk through the first 3 years of the model.
The study team analyzed data from Medicare claims and patient surveys from 2014 through 2019 and documented that across all episodes, OCM led to a relative savings of $297 per episode, not including the monthly payments or performance-based payments. This amount was 1% of the baseline $26,681 spent on care per episode, and these savings were not sufficient to cover the monthly payments to practices, which averaged $704 per episode. OCM was not associated with differences in hospitalizations, ED visits, patient experiences, survival, or most measures of quality. These results suggest that future models in oncology care may need to consider greater accountability, such as two-sided risk arrangements, to achieve savings.