In the first year, cancer centers that implement payment models with shared-savings components can be associated with fewer visits and lower costs, however these savings are largely offset by the cost of program administration (JAMA Netw Open. 2020;3[5]:e205165. doi:10.1001/jamanetworkopen.2020.5165).
“Health insurers reimburse clinicians in many ways, including the ubiquitous fee-for-service model and the emergent shared-savings models. Evidence on the effects of these emergent models in oncological treatment remains limited,” explained Brigham Walker, PhD, Data, Evidence & Insights, McKesson Life Sciences, The Woodlands, Texas, and colleagues.
In order to analyze the early use and cost associations of the Oncology Care Model (OCM), a Medicare payment program, Dr Walker and colleagues conducted a nonramdomized controlled study evaluating office visits, drug administrations, patient hydrations, drug costs, and total costs.
A difference-in-differences approach was used to evaluate data from July 1, 2015, to June 30, 2017 (1 year before and 1 year after the launch of the OCM). This approach was used to compare the differences between participating versus nonparticipating practices and controlled for patient, clinician, and practice factors.
Researchers estimated associations between participation and care use and cost for care directly managed by clinicians from a large network within their Medicare populations for breast, lung, colon, and prostate cancer. Data were analyzed from September 2019 to March 2020.
In addition to standard fee-for-service payments, practices who participated in the OCM were paid a monthly management fee of $160 per beneficiary as well as a potential risk-adjusted performance-based payment for eligible patients who received chemotherapy treatment.
Monthly mean data at the physician-level were evaluated for 11,869 physician-months for breast cancers, 11,135 physician-months for lung cancers, 8592 physician-months for colon cancers, and 9045 physician-months for prostate cancers.
Overall, participation in the OCM was associated with 24% less physician-administered prostate drug use (difference, 0.29 [95% CI, –0.47 to –0.11] percentage points) translating to a mean savings of $706 (95% CI, –$1383 to –$29) in drug costs per month. Monthly drug costs were also lower for treatment for lung cancer, with a mean savings of $558 (95% CI, –$1173 to $58).
Additionally, total costs were lower by 9.7% or $233 (95% CI, –$495 to $30) for breast cancer, 9.9% or $337 (95% CI, –$618 to –$55) for lung cancer, 14.2% or $385 (95% CI, –$780 to $10) for colon cancer, and 29.2% or $610 (95% CI, –$1095 to –$125) for prostate cancer; however, Dr Walker and coinvestigators noted that these differences were largely offset by program costs.
Lastly, researchers found that clinician visits were lower by 11.2% or 0.11 (95% CI, –0.20 to –0.01) percentage points among patients with breast cancer and by 14.4% or 0.19 (95% CI, –0.37 to –0.02) among patients with colon cancer.
“These findings suggest that payment models with shared-savings components can be associated with fewer visits and lower costs in certain cancer settings in the first year, but the savings can be modest given the costs of program administration,” Dr Walker and colleagues concluded.—Janelle Bradley
