Participation in OCM May Transform Care for Certain Cancer Types More Quickly Than Others

June 20, 2018

Physicians participating in the Oncology Care Model now provider care for approximately 21% of Medicare patients with cancer. An analysis from Avalere Health found that those doctors treat some types of cancers more than others.

Approximately 21% of Medicare patients with cancer are now receiving care from a physician participating in the Oncology Care Model (OCM), but with representation of cancer types varying, trends of participation in OCM could actually skew the transformation of cancer treatment more heavily for some cancers, according to Avalere Health.

A new report found that breast and lung cancers were the more common types of cancers with more than 25% of patients with breast and lung cancers treated by a doctor participating in the OCM.

Participation in the OCM has led oncologists to reshape their practices in order to deliver higher quality care at a lower cost, explained Dana Macher, vice president at Avalere. She added that the OCM has the potential to redefine care for all patients with oncology. However, the transformation of care may happen faster for some cancer types as a result of which patients are being cared for under OCM.

“About one-fifth of Medicare Part B fee-for-service patients are treated by a doctor participating in the Oncology Care Model, but those doctors are treating more of some cancer types than others,” Richard Kane, senior director at Avalere, said in a statement. “The Oncology Care Model may be accelerating oncology practice transformation for some cancers more than others.”

The OCM is a 5-year alternative payment model pilot that aligns financial incentives with care coordination, appropriateness of care, and access to care for beneficiaries receiving chemotherapy. The model has 2 forms of payment: a monthly enhanced oncology service payment for 21 cancers and a group of less common cancer types and the potential for performance-based payments for those 21 cancers.

Avalere estimates that a total of 2.2 million patients in Medicare Part B fee-for-service had the types of cancer covered in OCM. Of those patients 472,000 (21%) were receiving care from a doctor participating in OCM.

More than half of all patients being treated under the OCM have breast, prostate, lung, or small intestine/colon cancers, or lymphoma, according to the Avalere analysis.

The American Journal of Managed Care® will be hosting a webcast with experts to discuss practical experiences, challenges, and successes from within the OCM on June 28 at noon, 3 pm, and 6 pm EST. Learn more about the webcast.