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OCM Not Associated With Decreased Prescribing of Novel Cancer Therapies for Medicare Beneficiaries With Cancer
Findings from a recently published study reveal that participation in the Oncology Care Model (OCM) did not dissuade oncologists from prescribing expensive, novel therapies to Medicare beneficiaries with cancer. Moreover, the findings suggest that OCM financial incentives did not decrease patient access to novel therapies (JAMA Netw Open. 2022; 5(9):e2234161. doi:10.1001/jamanetworkopen.2022.34161).
“In an effort to improve care quality and reduce costs, the Centers for Medicare & Medicaid Services implemented a voluntary alternative payment plan called the Oncology Care Model (OCM) in 2016,” wrote Christopher R Manz, MD, MSHP, Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, and Department of Medical Oncology, Harvard Medical School, Boston, MA, and colleagues. “One concern that arose in the development of the OCM was how to account for the cost of expensive, novel anticancer drugs in the cost thresholds used to ascertain incentive payments.”
In this study, researchers sought to investigate whether oncologist participation in the OCM altered the probability that patients received novel therapies vs alternative treatments.
The cohort study utilized Surveillance, Epidemiology, and End Results (SEER) Program data and Medicare claims and compared patient receipt of novel therapies for patients treated by oncologists participating vs those not participating in the OCM in the period before (January 2015 to June 2016) and after (July 2016 to December 2018) OCM initiation. Participants included Medicare fee-for-service beneficiaries in SEER registries who were eligible to receive 1 of 10 novel cancer therapies that received FDA approval in the 18 months before implementation of the OCM.
Preplanned analyses assessed patient receipt of 1 of 10 novel therapies vs alternative therapies specific to the patient’s cancer for the overall study sample and for racial subgroups.
The study included 2839 matched patients (760 in the OCM group and 2,079 in the non-OCM group; median age, 72.7 [68.3-77.6] years; 1591 women [56.0%]). Among patients in the non-OCM group, 33.2% received novel therapies before and 40.1% received novel therapies after the initiation of the OCM vs 39.9% and 50.3% of patients in the OCM group (adjusted difference-in-differences, 3.5 percentage points; 95% CI, −3.7 to 10.7 percentage points; P = .34).
The researchers also examined several subgroups and the only significant difference discovered was that second-line immunotherapy use in lung cancer was greater among patients in the OCM group than the non-OCM group (P =.007).
During the pre- and post-OCM time periods, patients treated by oncologists participating in the OCM were 47% more likely to receive novel therapies than those whose oncologists did not participate (odds ratio, 1.47; 95% CI, 1.09-1.97; P =.01).
The authors concluded, “Despite concerns that the OCM inadequately considers the costs of novel therapies in calculating episode payments, the OCM had no discernable association with the overall likelihood that patients receive novel cancer therapies," adding, "In conjunction with previous studies, these results can inform the development and evaluation of cost and use incentives for Medicare’s new Enhancing Oncology Model.”
