Medicare’s Oncology Care Model (OCM) did not deter oncologists from prescribing more expensive novel cancer therapies, according to research published in JAMA Network Open.
The researchers explained that the OCM was an alternative payment model that tied performance-based payments to cost and quality goals.
“One concern that arose in the development of the OCM was how to account for the cost of expensive novel anticancer drugs in the cost thresholds used to ascertain incentive payments,” the researchers wrote.
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To examine whether the OCM altered the likelihood that patients received novel therapies, the researchers conducted a cohort study of SEER program data and Medicare claims.
The researchers compared receipt of novel therapies for patients treated by oncologists participating in the OCM (760 patients) and nonparticipating oncologists (2079 patients) before and after OCM initiation. Patients were matched on novel therapy cohort, outcome time period, and oncologist specialty status.
Among patients seen by oncologists participating in the OCM, 39.9% received novel therapies in the pre-OCM era and 50.3% did so after OCM initiation. Among patients in the non-OCM group, 33.2% received novel therapies in the pre-OCM era and 40.1% received novel therapies after OCM initiation. The difference between the OCM and non-OCM groups was not significant (P =.34).
The researchers also looked at several subgroups. The only significant difference identified was that second-line immunotherapy use in lung cancer was greater among patients in the OCM group than the non-OCM group (P =.007).
During the pre- and post-OCM eras, patients treated by oncologists participating in the OCM were 47% more likely to receive novel therapies than those whose oncologists did not participate (odds ratio [OR], 1.47; 95% CI, 1.09-1.97; P =.01).
“Despite concerns that the OCM inadequately considers the costs of novel therapies in calculating episode payments, the OCM had no discernable association with the overall likelihood that patients receive novel cancer therapies. In conjunction with previous studies, these results can inform the development and evaluation of cost and use incentives for Medicare’s new Enhancing Oncology Model,” the researchers wrote.
This study also revealed that Black patients were 39% less likely than White patients to receive novel therapies (OR, 0.61; 95% CI, 0.42-0.89; P =.009). However, the percentage of Black patients receiving novel therapies nearly doubled after OCM initiation.
Among Black patients seeing oncologists participating in the OCM, 27.8% received novel therapies in the pre-OCM era and 54.1% did so after OCM initiation. Among White patients with participating oncologists, 40.8% of patients received novel therapies in the pre-OCM era and 49.9% did so after OCM initiation.
“This finding raises the possibility that the OCM might have helped narrow racial disparities in patient access to novel therapies, which would be a noteworthy advance if it bears out in future research,” the researchers wrote.
Disclosures: This research was supported by grants from Genentech and the National Cancer Institute. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Manz CR, Tramontano AC, Uno H, Parikh RB, Bekelman JE, Schrag D. Association of oncologist participation in Medicare’s oncology care model with patient receipt of novel cancer therapies. JAMA Netw Open. Published online September 29, 2022. doi:10.1001/jamanetworkopen.2022.34161
