The Oncology Care Model and Medicare Payments, Utilization, and Quality.

Importance: The Oncology Care Model (OCM) was the Centers for Medicare & Medicaid Services' first cancer-focused alternative payment model, running from 2016 to 2022. The OCM aimed to reduce Medicare spending and improve quality of care for patients receiving chemotherapy. Objective: To evaluate the association of the OCM with changes in Medicare spending, utilization, and quality of care. Design, Setting, and Participants: Difference-in-differences (DID) regression analysis of 6-month chemotherapy episodes attributed to practices voluntarily participating in the OCM or propensity-matched comparison practices, adjusted for beneficiary, episode, practice, and regional characteristics. Episodes for fee-for-service Medicare beneficiaries were grouped into baseline (initiated January 2014-January 2016) and intervention (initiated July 2016-June 2022) periods. Main Outcomes and Measures: Total episode payments (Medicare spending for Parts A, B, and D, excluding OCM Monthly Enhanced Oncology Services [MEOS] payments); episode payments for Medicare Parts A, B, and D, hospitalizations, emergency department visits, and measures of quality. Results: The study population included 739 735 Medicare beneficiaries (mean age, 73.2 [SD, 8.6] years; 59.4% female; 1 746 368 episodes) undergoing chemotherapy (ie, traditional cytotoxic therapy, targeted therapy, immunotherapy, and hormonal therapy) at 202 OCM practices and 830 165 beneficiaries (mean age, 73.1 [SD, 8.8] years; 56.6% female; 1 919 516 episodes) at 534 comparison practices. Total episode payments increased from $29 206 (baseline period) to $36 190 (intervention period) for OCM episodes and from $28 788 to $36 388 for comparison episodes, for an OCM-associated spending change of -$616 [90% CI, -$912 to -$321]). Reductions in total episode payments increased over time (-$1282 in the final 6-month performance period). Statistically significant spending reductions were observed for Part A (DID, -$176 [90% CI, -$288 to -$63]) and Part B (DID, -$340 [90% CI, -$529 to -$149]) but not for Part D (DID, -$53 [90% CI, -$216 to $111]). The OCM was not associated with significant differences in hospitalizations, emergency department visits, or quality. Accounting for MEOS payments and performance-based incentive payments, the OCM resulted in an estimated net loss to Medicare of $639 million over 6 years. Conclusions and Relevance: The OCM was associated with modest reductions in Medicare payments during cancer treatment episodes without significant changes in care quality; payment reductions increased during the program's last 3 years. However, the OCM incurred a net loss because these estimated savings were exceeded by enhanced services payments and performance-based payments to practices.