The Oncology Care Model and Initiation of Systemic Therapy for Cancer.

Importance: The Centers for Medicare & Medicaid Services Oncology Care Model (OCM) was an episode payment model for patients with cancer; episodes were triggered by receipt of systemic cancer therapy. OCM provided monthly care management payments, and all practices were engaged in 1-sided risk in its early years. A concern about episode payment models triggered by use of a particular service is that they may prompt increases in episode volume. Objective: To assess if OCM is associated with an increase in the likelihood of initiating systemic therapy for cancer. Design, Setting, and Participants: This quasi-experimental study used matched difference-in-differences analysis of serial cross sections of Medicare beneficiaries with an index visit for cancer from January 2010 to December 2019 who were treated at OCM practices or matched practices not participating in the OCM and followed up for 1 year, comparing changes in outcomes before vs after OCM began in July 2016. Data were analyzed from October 2021 to November 2025. Main Outcomes and Measures: Systemic therapy initiation in the year after an index visit for newly diagnosed (incident) or poor-prognosis cancer; a secondary outcome examined total Medicare payments in the year after the index visit. Results: The study included 754 182 patient episodes (750 483 patients; mean [SD] age, 74.1 [9.0] years; 467 071 female [62.2%]) in the incident population and 517 858 patients (mean [SD] age, 72.4 [9.7] years; 270 416 female [52.2%]) in the poor prognosis cohort treated at 197 intervention and 197 comparison practices. There was no statistically significant differential change in the initiation of systemic therapy in the incident population (-0.9 percentage point difference; 95% CI, -2.2 to 0.3 percentage points; P = .14). Among patients with poor-prognosis cancers, there was a statistically significant differential decrease in the likelihood of systemic therapy initiation (1.5 percentage points, 95% CI, -2.8 to -0.2 percentage points; P = .03). Following OCM, there was a non-statistically significant relative decrease in spending (-$898.26; 95% CI, -$1890.31 to $93.80; P = .08) in the year after the index incident diagnosis and a statistically significant relative decrease (-$2192.15; 95% CI, -3559.66 to -833.63; P = .002) in the poor prognosis cohort. Conclusions and Relevance: Despite concerns about greater use of systemic therapy for patients with cancer under 1-sided risk, this study found that the OCM was not associated with an increase in the likelihood of initiating systemic therapy episodes among patients with incident cancers but was associated with less chemotherapy initiation and lower spending among patients with poor-prognosis cancers. By not examining changes in chemotherapy initiation, the OCM evaluation may have underestimated savings related to the model.