Value-Based Care in Oncology Gets off to Shaky Start

MHE Publication, MHE December 2021, Volume 31, Issue 12

The Oncology Care Model (OCM) was CMS’ main attempt to usher value-based care into oncology. What will come after OCM is unclear as the future of successor, Oncology Care First, is now very much in doubt.

The Oncology Care Model (OCM) was CMS’ main attempt to usher value-based care into oncology. What will come after OCM is unclear as the future of successor, Oncology Care First, is now very much in doubt. Regardless, results of a study of OCM’s first three years may give some value-based care proponents pause.

The 201 practices that volunteered to participate in the model spent $297 less per six-month episode of care than 534 practices in a comparison group, reported Nancy Keating, M.D., M.P.H., a professor of health care policy at Harvard Medical School and the lead author of the study published in JAMA Oncology in November. But that savings was offset by an average of $704 in extra payment to the participating practices to cover the cost of enhanced services, such as creation of care plans and around-the-clock access to clinicians. As a result, OCM wound up costing the Medicare program $315.6 million over a two-and-a-half-year period, according to calculations by Keating and her colleagues.

Others have previously reported on OCM’s less-than-stellar results; the study by Keating paints a more complete picture.

An accompanying editorial noted that new and expensive immunotherapy and targeted therapies were introduced during the period when practices were participating in OCM. Those new therapies constrained the ability of oncologists to make cost-saving substitutions and perhaps realize some of the potential of value-based care, wrote Raymond Osarogiagbon, M.B.B.S., of Baptist Memorial Health Care in Memphis, Tennessee, and Samyukta Mullangi, M.D., and Deborah Schrag, M.D., M.P.H., both of Memorial Sloan Kettering Cancer Center in New York City. They noted that drug costs account for an increasingly large share of the cost of cancer and including them in value-based care arrangements
is “problematic.”

OCM might be viewed as the 1.0 of value-based care for oncology, with the not-great results chalked up to the learning curve. Oncology Care First was going to be the chance to iron out some of the problems by, among other things, moving toward prospective capitated payment and gearing benchmarks to specific cancers. Officials at the Center for Medicare & Medicaid Innovation have said they now expect there to be a gap between when OCM ends in June 2022 and when a successor starts. The Biden administration CMS is putting an emphasis on equity issues, so equity is likely to be an important part of whatever comes after OCM.