scholarly journals PCN214 WHAT FACTORS ARE ASSOCIATED WITH EXCEEDING TARGET PRICE IN BREAST CANCER EPISODES UNDER THE ONCOLOGY CARE MODEL?

2020 ◽  
Vol 23 ◽  
pp. S60
Author(s):  
R. Thomas ◽  
S. Park ◽  
D.D. Waters ◽  
A. Song ◽  
V. Csik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Model ◽  
Target Price ◽  
Oncology Care

Breast Cancer Stage Is Associated With Exceeding Target Price in the Oncology Care Model

2021 ◽  
Author(s):  
Ryan B. Thomas ◽  
Vittorio Maio ◽  
Anna Chen ◽  
Seojin Park ◽  
Dexter Waters ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Academic Medical Center ◽  
Stage Iv ◽  
Cost Of Care ◽  
Mean Difference ◽  
Cancer Stage ◽  
Care Model ◽  
Target Price ◽  
Old Patients ◽  
Oncology Care

PURPOSE: To explore mean difference between Oncology Care Model (OCM) total costs and target price among breast cancer episodes by stage under the Centers for Medicare and Medicaid Services OCM payment methodology. METHODS: Breast cancer episodes from OCM performance period 1-4 reconciliation reports (July 1, 2016-July 1, 2018) were linked with health record data from a large, academic medical center. Demographics, total cost of care (TCOC), and target price were measured by stage. Adjusted differences between TCOC and target price were compared across cancer stage using multivariable linear regression. RESULTS: A total of 539 episodes were evaluated from 252 unique patients with breast cancer, of which 235 (44%) were stage I, 124 (23%) stage II, 33 (6%) stage III, and 147 (27%) stage IV. About 37% of episodes exceeded target price. Mean differences from target price were –$1,782, $2,246, –$6,032, and $11,379 all in US dollars (USD) for stages I through IV, respectively. Stage IV episodes had highest mean TCOC ($44,210 USD) and mean target price ($32,831 USD) but also had higher rates of chemotherapy, inpatient admission, and novel therapy use. After adjusting for covariates, stage IV and ≥ 65-year-old patients had the highest mean difference from target price ($17,175 USD; 95% CI, $12,452 to $21,898 USD). CONCLUSION: Breast cancer episodes in older women with distant metastases most frequently exceeded target price, suggesting that target price did not adequately account for complexity of metastatic cancers. A metastatic adjustment introduced in PP7 represents a promising advancement in the target price methodology and an impact evaluation will be needed.

Pursuit of performance: An exploration of predictors associated with achieving performance based payments for breast cancer episodes under the Oncology Care Model.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18035-e18035
Author(s):  
Andrew Jehyun Song ◽  
Arianna Kee ◽  
Jared Minetola ◽  
Karen Walsh ◽  
Valerie P Csik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Systemic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Novel Therapies ◽  
Care Model ◽  
Logistic Regression Models ◽  
Multivariable Logistic Regression ◽  
Oncology Care

e18035 Background: The Oncology Care Model (OCM) captures patient costs in a 6-month episode triggered by administration of systemic therapy. Most breast cancer (BC) patients will receive systemic therapy, with variations depending on stage and hormonal status, which makes BC an ideal indication to study costs in the OCM. Practices earn performance based payments (PBP) if aggregate episodic expenditures are managed below set target prices. We investigated predictors for episodic expenditures exceeding target prices, thus reducing potential for PBP. Methods: We identified BC episodes with non-decedent beneficiaries attributable to our academic medical center from OCM Reconciliation Reports during 7/1/16-6/30/17. Cohorts were defined as episodes whose costs were above target (Cohort 1) and those below (Cohort 2). The Wilcoxon Rank-Sum test was used to compare actual and target episode expenditure between cohorts. Multivariable logistic regression models were used to assess association of maintaining costs below target due to various predictors. Results: A total of 369 episodes were included in the study, with 124 episodes in Cohort 1 and 245 in Cohort 2. Median actual and target episode expenditures were higher in Cohort 1 (actual: $23,466 vs. $2,691, p < 0.0001; target: $8,425 vs. $5,870, p < 0.0001). In multivariable logistic regression, episodes were more likely to be below target if novel therapies, Part B drugs, or inpatient admissions were not utilized, controlling for other predictors (see Table). Conclusions: Large disparities exist for both actual expenditures and target prices for BC episodes in the OCM. Novel therapies, Part B drugs, and inpatient admissions are negatively associated with maintaining episode expenditures below target. Risk-adjustments for these expenditures need to be overhauled in OCM to accurately capture costs associated with management of cancer patients, and provide practical target prices for institutions to continue delivery of value based care. [Table: see text]

Factors associated with target price status within the oncology care model population.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 72-72
Author(s):  
Matthew Molaei ◽  
Karen Walsh ◽  
Scott W. Keith ◽  
Valerie Pracilio Csik ◽  
Amy Leader ◽  
...  
Keyword(s):  
Drug Use ◽  
Radiation Treatment ◽  
Cost Of Care ◽  
Medicare Part ◽  
Cancer Type ◽  
Cancer Stage ◽  
Care Model ◽  
Target Price ◽  
Medicare Part B ◽  
Oncology Care

72 Background: The Oncology Care Model (OCM) is an alternative payment model put forth by the Centers for Medicare and Medicaid Services (CMS), which aims to improve quality of care for cancer beneficiaries, while reducing cost. One of the strategies implemented by CMS to achieve this goal was the development of an episode target price (TP), which uses historical data and episode specific adjusters to calculate a total cost of care goal for each episode. The goal of this analysis was to better understand how CMS risk adjustments could account for episode characteristics, as well as how these characteristics affect likelihood of meeting target price. Methods: OCM performance claims data were abstracted retrospectively from performance periods (PP) 1-6 (episodes initiated from 7/1/2016 – 12/31/2019), in which each episode captured 6 months of care. EHR data was linked to identify cancer staging for OCM Beneficiaries. Any OCM beneficiary with at least one episode in PP 1-6 was included. To assess odds of meeting TP, a logistic regression model with a generalized estimating equation was used to account for patients who contributed multiple episodes. Specific factors evaluated for their association with meeting TP included patient’s age and sex, cancer stage, cancer type, cancer related surgery, clinical trial participation, hospice status, inpatient admissions, observational stays, Medicare part B drug use and radiation therapy. Results: 4,612 episodes were included in analysis, which translated to 2,459 patients, who had an average age of 72 years old and were majority female (50.5%). 2,790 (60.5%) of the episodes met the TP set by OCM. When controlling for covariates, radiation treatment (OR = 1.75, 95%CI: 1.39-2.23), stage 2 compared to stage 4 cancers (OR = 1.86, 95%CI: 1.23-2.80), colorectal cancers (OR = 1.75, 95%CI: 1.11-2.77) and melanomas (OR = 4.35, 95%CI: 2.18-8.67) were significantly associated with increased odds of meeting TP. Novel therapies (OR = 0.19, 95%CI: 0.14-0.26), inpatient admissions (OR = 0.27, 95%CI: 0.22-0.33), observational stays (OR = 0.66, 95%CI: 0.51-0.87) and part B drug use (OR = 0.75, 95%CI: 0.60-0.93) were associated with significantly reduced odds of meeting TP. Conclusions: Our analysis suggests that radiation treatment, as well as selected cancer stage and types may contribute to increased likelihood of meeting TP, which may point to potential areas of cost savings. Conversely, specific resource utilizations such as novel therapy use, inpatient admissions, observational stays, and Medicare part B drug use may decrease the odds of meeting TP, despite being adjusted for in the OCM model. While CMS has recognized that late stage cancers require a more sensitive TP with the metastatic adjustment, other adjustments should also be considered to adequately account for episode characteristics. External validation at other OCM-participating practices is needed to corroborate these results.

The Oncology Care Model and lung cancer: Retrospective review of claims and clinical data at a large academic medical center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 62-62
Author(s):  
Chetan Vakkalagadda ◽  
Bijal Desai ◽  
Nisha Anjali Mohindra ◽  
Sheetal Mehta Kircher
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Systemic Therapy ◽  
Small Cell ◽  
Drug Costs ◽  
Care Model ◽  
Small Cell Lung ◽  
Target Price ◽  
Total Cost ◽  
Oncology Care

62 Background: The Oncology Care Model (OCM) is a Center for Medicare and Medicaid Innovation (CMMI) alternative payment model designed to enhance value in cancer care. Based on a practice’s historical performance, the model predicts a target price for a 6-month episode of care and adjusts for factors such as age, modality received, geographic location, trend factor, and receipt of a novel therapy. Practices are incentivized to reduce costs of care, allowing for a performance based payment if the total cost of care is below the predicted OCM target price. At our OCM practice, when compared to other malignancy types, lung cancer has disproportionately failed to meet the OCM target. The purpose of our review was to explore the contribution of systemic therapy to total cost within the OCM model for lung cancer episodes. Methods: We reviewed claims and clinical data for the OCM Performance Period 6 (PP6), which corresponds to episodes beginning between 1/2/19-7/1/19 and ending between 7/2/19-12/31/19, for all OCM lung cancer episodes at Northwestern Medical Group. Results: 142 patients were identified with non-small cell (n = 128, 91%) and small cell lung cancer (n = 14, 9%). Patients received a PD1 inhibitor either alone or in combination with chemotherapy (n = 87), tyrosine kinase inhibitors (n = 18), both a PD1 inhibitor and a TKI (n = 2), or chemotherapy alone (n = 35). All systemic therapy use was deemed guideline compliant. 46 patients (33%) had at least 1 cancer-related hospital admission during the episode. 19 patients (13.4%) died during the OCM performance period. 39/142 (27.5%) of patients’ episode costs achieved the OCM target. Among the 103 patients whose total costs exceeded the target, drug costs alone exceeded the target in 67 (65%). Drug costs alone exceeded the total target in 59% (n = 63/107) of those who received PD1 inhibitor or TKI therapy and 11.4% (4/35) of those who received chemotherapy alone. 94% (n = 63/67) of patients for whom drug costs alone exceeded the OCM target received anti-PD1 therapy or a TKI. Conclusions: Drug cost alone exceeded the total target in the majority of OCM lung cancer episodes that did not achieve savings, highlighting the dominant role drugs play in the OCM model. With targeted therapy and immunotherapy already the standard of care in metastatic non-small cell lung cancer, and gaining a foothold in earlier stages of disease, accounting for these therapies in the OCM target price methodology will be critical for oncology practices to be successful within such value-based payment models.

Impact of the Oncology Care Model on use of bone supportive medications, antiemetics, and growth factors.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1517-1517
Author(s):  
Gabriel A. Brooks ◽  
Mary Beth Landrum ◽  
Nirav S. Kapadia ◽  
Pang-Hsiang Liu ◽  
Robert R Wolf ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Growth Factors ◽  
Supportive Care ◽  
Serotonin Antagonists ◽  
Care Model ◽  
Point Reduction ◽  
Percentage Points ◽  
Oncology Care ◽  
Prophylactic Use

1517 Background: The Oncology Care Model (OCM) is a voluntary, episode-based alternative payment model for cancer care launched by the Centers for Medicare & Medicaid Services in July 2016. OCM incentivizes participating practices to reduce spending during chemotherapy treatment while maintaining quality of care. We evaluated the impact of OCM on the use of costly supportive care medications. Methods: Using 100% Medicare claims (2013-2019), we evaluated use of outpatient supportive care medications during chemotherapy episodes assigned to OCM practices (n = 186) or propensity-matched comparison practices (n = 534). For bone supportive medications, we evaluated use of bisphosphonates and/or denosumab in beneficiaries with bone metastases from breast, lung, or prostate cancer. For anti-emetic drugs, we evaluated prophylactic use of neurokinin-1 (NK1) antagonists and long-acting (LA) serotonin antagonists. For white blood cell growth factors (GCSFs), we evaluated prophylactic use in beneficiaries starting chemotherapy for breast, lung, or colorectal cancer; we separately evaluated use of biosimilar (vs originator) filgrastim. Analyses employed the difference-in-differences (DID) approach, excepting the filgrastim biosimilar analysis where we assessed the adoption trend. Results: There was no OCM impact on receipt of any bone supportive medication (denosumab or bisphosphonate) among beneficiaries with bone metastases; however, OCM led to a relative decrease in use of denosumab for breast cancer (DID = -5.0 percentage points [90% CI -7.1, -2.8]), prostate cancer (-4.0 percentage points [90% CI -5.9, -2.2]), and lung cancer (-4.1 percentage points [90% CI -7.4, -0.9]). In beneficiaries starting chemotherapy regimens with high or moderate emetic risk, OCM led to reductions in prophylactic use of NK1 antagonists and LA serotonin antagonists (e.g. 6.0 percentage point reduction in use of NK1 antagonists during high emetic risk chemotherapy [90% CI -9.0, -3.1]); there was no impact on antiemetic use during low emetic risk chemotherapy. There was no OCM impact on use of prophylactic WBC growth factors among beneficiaries receiving chemotherapy with high risk for febrile neutropenia (FN). Among beneficiaries receiving chemotherapy with intermediate risk for FN, OCM led to a 7.6 percentage point reduction in prophylactic GCSF use for patients with breast cancer (90% CI -12.6, -2.7); however, there was no OCM impact on prophylactic GCSF use in patients with lung or colorectal cancer. Among beneficiaries receiving filgrastim, OCM led to faster adoption of biosimilar vs. originator filgrastim (differential trend estimate 2.6%, 90% CI 1.0, 4.4). Conclusions: OCM led to reduced use of some high cost supportive care medications, with patterns suggesting more value-conscious care. Alternative payment models have potential to drive value-based changes in medication use during cancer care.

Predictors of increased episode expenditure and exceeding target price under the oncology care model.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19403-e19403
Author(s):  
Seojin Park ◽  
Dexter Waters ◽  
Ryan Thomas ◽  
Andrew Jehyun Song ◽  
Karen Walsh ◽  
...  
Keyword(s):  
Current Model ◽  
Hematologic Malignancies ◽  
Care Model ◽  
Target Price ◽  
Novel Therapy ◽  
Part D ◽  
Home Health Aides ◽  
Solid Malignancies ◽  
Oncology Care ◽  
Cancer Types

e19403 Background: The Oncology Care Model (OCM) incentivizes participants to keep episode expenditure below target price; however, little is known about the adequacy of adjustments in target price calculation. This study investigates predictors of increased expenditures and explores how these predictors are associated with exceeding target price for hematologic and solid malignancies. Methods: Non-decedent OCM episodes, categorized as hematologic malignancies (HMs) or solid malignancies (SMs), from 7/1/2016 - 7/1/2018 attributed to our institute were analyzed. Multiple linear regression was used to identify factors associated with increased episode expenditure. Multiple logistic regression was used to evaluate whether such factors increased likelihood of expenditure exceeding target price. Results: Of 1,975 episodes, 499 (25.3%) were HMs and 1,476 (74.7%) were SMs. 54.3% of HMs and 35.2% of SMs had episode expenditure exceeding target price. In HMs, novel therapy use (NT), inpatient admission (INPT), Part B drug use (PB), Part D use (PD), and radiation therapy (XRT) were associated with increased episode expenditure. Of those, INPT and PD increased the likelihood of expenditure exceeding target price. XRT decreased the likelihood of expenditure exceeding target price (Table). In SMs, NT, INPT, emergency department visit, home health aides, durable medical equipment use, PB, PD, XRT, and surgery were associated with increased episode expenditure. Of those, NT, INPT, PB and PD increased the likelihood of expenditure exceeding target price. XRT and receipt of surgery decreased the likelihood of expenditure exceeding target price (Table). Conclusions: INPT and PD significantly increased episode expenditures in both HMs and SMs, leading to expenditures exceeding target prices determined by the OCM benchmark risk-adjustments in both cancer types. NT and PB were significant predictors of increased expenditure and the likelihood of exceeding target price in SMs, but not in HMs. Our findings suggest that there may be opportunities to improve the current model by refining the adjustment for these factors to better reflect real world expenditures. [Table: see text]

Early physician spillover responses to the oncology care model.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19393-e19393
Author(s):  
Brigham Walker
Keyword(s):  
Breast Cancer ◽  
Spillover Effects ◽  
First Year ◽  
Limited Information ◽  
Office Visits ◽  
Care Model ◽  
Medicare Population ◽  
Before And After ◽  
Care Patterns ◽  
Oncology Care

e19393 Background: As Medicare increasingly seeks to transform beneficiary care through provider reimbursement incentives, there is a possibility that non-beneficiary care will change too. There is limited information on how the Oncology Care Model (OCM) has affected care in this way. This study seeks to analyze the early utilization and cost effects of the OCM on the non-Medicare population. Methods: This was a retrospective analysis of a large physician network comprised of OCM participants and non-participants alike. The data spanned July 1st, 2015 to June 30th, 2017 – one year before and after the launch of the OCM. Several states are represented, and this population includes about 20% of the non-hospital-based community oncology footprint. A difference-in-differences approach was used to compare primary first-year effects on the Medicare population with first-year spillover effects on the Medicare Advantage (MA), private, and Medicaid populations. The utilization and costs of care under management of the practices were evaluated. Effects of the OCM for breast, lung, colon, and prostate cancer among Medicare, MA, private, and Medicaid populations at the physician-by-month level are estimated. Results: The OCM appears to have reduced office visits for Medicare breast cancer and colon cancer. These effects look to have spilled over to the Medicaid breast cancer population, but not elsewhere. The OCM also modestly decreased overall costs for each sub-type but these reductions were not observed in the non-Medicare populations. Conclusions: This research was not randomized, so un-observable differences between groups unrelated to the OCM could drive these results. It is also limited to practice-based care and does not include hospital or pharmacy care. Finally, these are first year effects and the literature suggests that effects can develop for a few years after program launch. That said, this paper suggests that care patterns appear to have changed under the OCM for both Medicare and non-Medicare lives, but not uniformly.

scholarly journals Influence of Pomalidomide and Lenalidomide on Total Cost of Care for Medicare Beneficiaries with Multiple Myeloma Under the Oncology Care Model (OCM)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2252-2252 ◽  
Author(s):  
Haley Hines Theroux ◽  
Luis M Isola ◽  
Mark Liu ◽  
Alaysia Williams
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Cost Of Care ◽  
Cancer Type ◽  
Novel Therapies ◽  
Care Model ◽  
Target Price ◽  
Total Cost ◽  
Oncology Care ◽  
The Impact

Abstract Background: In July of 2016, CMMI started a five year bundled payment program called OCM. Beneficiaries are attributed to practices providing their cancer care for a 6 month episode triggered by the administration or distribution of specified cancer drugs. The model provides risk adjustments to the target price based on risk factors such as age, chemotherapy and the receipt of certain treatments (radiation or bone marrow transplant). Target prices are adjusted by geographic region, novel therapy use, and a trend factor. Multiple Myeloma was identified in our practice as a cancer type with high variance on expenditures after the first Performance Period within the model (July 2016-December 2016). Chemotherapy represented 52% of total episode expenditures with oral chemotherapy and hormone therapy representing 24%. The average cost of lenalidomide for one year is $115,000. The model adjusts for novel therapies, including new drugs approved by the FDA after December 31, 2014 with status lasting two years. However, literature demonstrates that this does not fully adjust for the high costs of novel therapies (Muldoon et at., Health Affairs, 2018). Unlike solid tumors, Multiple Myeloma staging may not improve risk adjustment and target price. Methods: We analyzed the total cost of care of beneficiaries who triggered an OCM episode for Performance Period 1 (PP1). Beneficiaries were identified by diagnosis of Multiple Myeloma, and then segregated into cohorts of those who received lenalidomide and/or pomalidomide and those who did not. Observed vs. Expected (O/E) target price for each episode was determined for both cohorts comparing the actual episode expenditures and the target price per episode calculated by the Oncology Care Model. A two sample t-test was conducted followed by a linear regression to determine relation between drug days prescribed and O/E. Results: There were 125 attributed beneficiaries with a Multiple Myeloma diagnosis who triggered an episode during PP1. The average O/E of the cohort which received the chemotherapy, Cohort A, was 1.624 compared to 0.986 for those that did not, Cohort B. The difference in average O/E in the two cohorts was 39% higher in Cohort A, p<0.001. There were no significant differences in the amount of inpatient claims, ED visits, or Bone Marrow Transplants between the two cohorts (Table 1). Figure 1 demonstrates the positive linear relationship (p<0.01, r=.40) between number of days supplied and O/E. Discussion: This is the first report on the impact of lenalidomide and pomalidomide on the total cost of care in an OCM practice. The results demonstrate the lack of adequate adjustment to the CMS target price for episodes in which one or both of these drugs were prescribed. Lenalidomide and pomalidomide are first and second line drugs used both for induction and maintenance. Both drugs are frequently used for prolonged periods of time in patients and trigger more than one episode in OCM. Therefore, the use of these agents greatly affects the total cost of care against a target price that is not adequately adjusted. Academic Medical Centers that care for larger populations of multiple myeloma patients may be disproportionately affected and this will impede their success under the OCM methodology. Additional analysis similar to this will inform CMMI as to further refinements to the OCM adjusters. Disclosures No relevant conflicts of interest to declare.

scholarly journals Multiple Myeloma Cost of Care Under the Oncology Care Model: The Influence of High-Cost Therapies

2020 ◽  
pp. JOP.19.00569 ◽  
Author(s):  
Haley Theroux ◽  
Alaysia Williams ◽  
Mark Liu ◽  
Alyssa Dahl ◽  
Theresa Dreyer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Primary Objective ◽  
Cost Of Care ◽  
Care Model ◽  
Target Price ◽  
Chemotherapy Agent ◽  
Significant Difference ◽  
Episodes Of Care ◽  
Oncology Care ◽  
The Impact

PURPOSE: As expenditures for cancer care continue to grow substantially, value-based payment models are being tested to control costs. The Oncology Care Model (OCM) is the largest value-based payment program in oncology. The primary objective of this analysis was to determine the impact of high-cost novel agents on total cost of care for multiple myeloma (MM) episodes of care in the OCM. METHODS: This was a retrospective analysis using Medicare claims data for 258 MM OCM episodes initiated between July 1, 2016, and July 1, 2017. Patients were organized into 3 cohorts: those who received pomalidomide (cohort A), those who received lenalidomide (cohort B), and those who did not receive either drug but had received another chemotherapy agent (cohort C). We compared the actual episode expenditures and the Centers for Medicare and Medicaid target price to create an observed versus expected (O/E) ratio. RESULTS: The average O/E for cohort A (n = 73) was 1.73, compared with 1.31 for cohort B (n = 84) and 1.01 for cohort C (n = 101). The difference the in O/E ratio among the groups was statistically significant ( P < .001). The average episode target price for cohorts A, B, and C was $66,149, $63,483, and $63,937, respectively. Despite the high cost of pomalidomide and lenalidomide, there was no significant difference in the average episode target prices of the cohorts. CONCLUSION: The O/E ratio and target prices of the cohorts demonstrate a lack of adequate adjustment to the OCM target price for episodes in which pomalidomide and lenalidomide were used to treat patients with MM.

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