Practice patterns among oncologists participating in the oncology care model after three years

Abstract

Background: The Oncology Care Model (OCM) incentivized care coordination and cost-efficiency and has been associated with short-term care reductions, but its multi-year associations are less well-studied.

Methods: We used monthly provider-level claims data spanning nearly five years between July 1 st, 2014 and May 30th, 2019 from a large community oncology practice network where roughly half of the practices participated in the OCM. The key outcome measures were monthly mean office visits, costs, and buy-and-bill drug costs among prostate, colon, breast, and lung cancers. We conducted two quasi-experimental analyses: an event study, which measures the monthly association of providing care in an OCM relative to a non-participating practice, and a difference-in-differences model, which summarizes the event study results into post-launch average estimates. We controlled for mean differences between practices, providers, and patient.

Results: The event study analysis shows similar pre-period estimates and trends for each cancer. The difference-in-differences estimates for office visits are statistically significant for each cancer: 33 percentage point reductions in prostate cancer (95 % CI: -0.66 to 0.00; p = 0.05), 22 percentage point reductions in colon cancer (95 % CI: -0.48 to 0.04; p = 0.09), 21 percentage point reductions in breast cancer (95 % CI: -0.45 to 0.02; p = 0.08), and 24 percentage point reductions in lung cancer (95 % CI: -0.49 to 0.00; p = 0.05). Monthly prostate cancer costs also reduced by $505 (95 % CI: -$1108 to $99; p = 0.10).

Conclusion: Our results suggest that the OCM was associated with relative reductions in office visits and, for prostate cancer, in overall costs too. These associations generally decreased within the first year of launch and sustained through roughly two years.

Policy summary: Novel payment models that incentivize care coordination and cost-efficiency like the OCM may modestly yet sustainably reduce office visits and overall costs.

Keywords: Accountable Care Organizations (ACOs); Cancer; Oncology Care Model (OCM); Reimbursement reform; Shared-savings models; Value-based care models.