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

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.