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Sustained Impacts in the Oncology Care Model: Medicare Payment Impacts in the 18 Months After the Model's End
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ABSTRACT
Objective
To evaluate whether payment reductions achieved during the Oncology Care Model (OCM) continued after the model ended.
Study Setting and Design
OCM was a voluntary episode‐based alternative payment model designed to improve the value of care for Medicare beneficiaries receiving chemotherapy for cancer. Participating practices received $160 monthly care coordination payments and could receive shared savings (or penalties) according to quality and spending goals during 6‐month episodes. We extended the OCM regression‐adjusted difference‐in‐differences (DID) payment analysis by 18 months after the model's conclusion to assess sustained effects on total episode payments (TEP) and component Parts A, B, and D, and Part B drug payments.
Data Sources and Analytic Sample
We used Medicare administrative data, model program data, and secondary sources describing market and provider characteristics to analyze 6‐month chemotherapy episodes for Medicare fee‐for‐service beneficiaries initiated during January 2014–July 2015 (baseline), July 2016–December 2021 (performance), and January 2022–June 2023 (post‐performance).
Principal Findings
In the 18 months following OCM's end, on average, OCM practices reduced TEP by −$955, driven by significant reductions in Part B payments (−$559). Part B payment reductions were primarily for non‐chemotherapy drugs (−$489). Overall payment reductions totaled $328 million. Sustained payment reductions were predominantly among practices adopting two‐sided risk; these practices reduced TEP by $3379, including significant reductions in Parts A (−$738), B (−$1370), and D (−$1112) payments.
Conclusion
OCM savings following the model's end were driven by practices that adopted two‐sided risk. These sustained payment reductions after OCM's conclusion provided substantial additional savings for CMS, reducing estimated model losses from $639 million to $311 million.
Title: Sustained Impacts in the Oncology Care Model: Medicare Payment Impacts in the 18 Months After the Model's End
Description:
ABSTRACT
Objective
To evaluate whether payment reductions achieved during the Oncology Care Model (OCM) continued after the model ended.
Study Setting and Design
OCM was a voluntary episode‐based alternative payment model designed to improve the value of care for Medicare beneficiaries receiving chemotherapy for cancer.
Participating practices received $160 monthly care coordination payments and could receive shared savings (or penalties) according to quality and spending goals during 6‐month episodes.
We extended the OCM regression‐adjusted difference‐in‐differences (DID) payment analysis by 18 months after the model's conclusion to assess sustained effects on total episode payments (TEP) and component Parts A, B, and D, and Part B drug payments.
Data Sources and Analytic Sample
We used Medicare administrative data, model program data, and secondary sources describing market and provider characteristics to analyze 6‐month chemotherapy episodes for Medicare fee‐for‐service beneficiaries initiated during January 2014–July 2015 (baseline), July 2016–December 2021 (performance), and January 2022–June 2023 (post‐performance).
Principal Findings
In the 18 months following OCM's end, on average, OCM practices reduced TEP by −$955, driven by significant reductions in Part B payments (−$559).
Part B payment reductions were primarily for non‐chemotherapy drugs (−$489).
Overall payment reductions totaled $328 million.
Sustained payment reductions were predominantly among practices adopting two‐sided risk; these practices reduced TEP by $3379, including significant reductions in Parts A (−$738), B (−$1370), and D (−$1112) payments.
Conclusion
OCM savings following the model's end were driven by practices that adopted two‐sided risk.
These sustained payment reductions after OCM's conclusion provided substantial additional savings for CMS, reducing estimated model losses from $639 million to $311 million.
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