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Cancer Types Can Impact How Well Providers May Perform Under OCM

Laura Joszt
The type of cancer a provider treats can determine how well he or she performs under the Oncology Care Model (OCM), according to research from Avalere Health that was presented at the American Society of Clinical Oncology Quality Care Symposium.
The type of cancer a provider treats can determine how well he or she performs under the Oncology Care Model (OCM), according to research from Avalere Health that was presented at the American Society of Clinical Oncology Quality Care Symposium.

The Avalere researchers constructed and analyzed OCM episodes using Medicare Part A/B fee-for-service claims and Part D prescription drug event data. They then compared the average actual Medicare costs with the OCM predicted costs for each of 21 types of cancer included in the OCM.

First, they found that 62% of the cancer episodes occurring during the OCM baseline period were either breast or prostate cancer. While the average and predicted OCM episode for the baseline period was $20,900 across all cancer types, the average and predicted costs varied for individual cancer types. For instance, actual costs were an average 8% higher than predicted in lung and liver cancer episodes. Meanwhile, the actual costs for bladder and female genitourinary cancers other than ovarian were 5% lower on average compared with the predicted costs.

“As the shift towards value-based care continues, it is important to evaluate how new payment models like the Oncology Care Model may affect physicians and patients,” Richard Kane, senior director at Avalere, said in a statement. “Our research suggests that clinicians who treat certain cancer types may perform better under the Oncology Care Model.”
Performance on quality scores also varied by cancer type with acute leukemia and head-and-neck cancers performing worse (none of the possible quality points were achieved). However, in bladder cancers, 92% of the possible quality points were achieved, on average. According to the research, 8 cancer types that account for 80% of OCM episodes achieved, on average, more than 50% of possible quality points. In comparison, the 11 cancer types that account for just 20% of OCM episodes achieved, on average, less than 50% of possible quality points.

Overall, the Avalere researchers determined that the “ability of a participant to succeed in the OCM can vary depending on the types of cancers treated by the practice.”

“Cancer episodes for which actual costs are greater than predicted costs and for which quality scores are low will adversely affect a participant’s ability to earn performance-based payments,” said Matt Brow, president of Avalere. “Identifying these types of challenges are essential to ensuring the Oncology Care Model succeeds in rewarding efficient and high-quality care.”

Previously, Avalere found that participation in the OCM may transform care more quickly for certain types of cancers as participating doctors treat some types more than others. For instance, breast and lung cancers were the most common types of cancers treated by a doctor in the OCM.

The American Journal of Managed Care® will be hosting a webcast with experts to discuss the current and future strategy for OCM participation, as well as to identify key lessons from the OCM and how they can be applied in other reform models. The webcast will be held on October 25 at noon, 3 pm, and 6 pm EST. Learn more about the webcast.

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