Mullangi Samyukta, Ukert Benjamin, Devries Andrea, Debono David, Santos Jason, Fisch Michael J, Schleicher Stephen M, Navathe Amol S, Bekelman Justin E, Schwartz Aaron L, Parikh Ravi B
Tennessee Oncology, Nashville, TN.
Thyme Care, Nashville, TN.
J Clin Oncol. 2025 Jan 10;43(2):133-142. doi: 10.1200/JCO.24.00502. Epub 2024 Oct 2.
The Oncology Care Model (OCM), a value-based payment model for traditional Medicare beneficiaries with cancer, yielded total spending reductions that were outweighed by incentive payments, resulting in net losses to the Centers for Medicare & Medicaid Services. We studied whether the OCM yielded spillover effects in total episode spending, utilization, and quality among commercially insured and Medicare Advantage (MA) members, who were not targeted by the program.
This observational study used administrative claims from a large national payer, yielding 157,189 total patients with commercial insurance or MA with solid malignancies who initiated 229,376 systemic anticancer therapy episodes before (2012-2015) and during (2016-2021) the OCM at 125 OCM-participating practices (a subset of total OCM practices) and a 1:10 propensity-matched set of 860 non-OCM practices. We used difference-in-differences analyses to assess the association between the OCM and total episode spending, defined as medical spending during a 6-month episode. Secondary outcomes included hospitalization and emergency department (ED) utilization and quality measures.
From the pre-OCM to the OCM period, mean total episode payments increased from $45,504 in US dollars (USD) to $46,239 USD for OCM-participating practices, and increased from $50,519 USD to $58,591 USD for non-OCM practices (adjusted difference-in-differences -$6,287 USD [95% CI, -$10,076 USD to -$2,498 USD], = .001). The OCM was associated with adjusted spending decreases for both high-risk (-$6,756 USD [95% CI, -$10,731 USD to -$2,781 USD], = .001) and low-risk (-$4,171 USD [95% CI, -$7,799 USD to -$543 USD], = .025) episodes. OCM-associated spending reductions were strongest for outpatient (-$5,243 USD [95% CI, -$8,589 USD to -$1,897 USD], = .002) and infused/injected anticancer drug (-$3,031 USD [95% CI, -$5,193 USD to -$869 USD], = .006) spending. There were no associations between OCM participation and changes in hospital or ED utilization nor quality of care.
The OCM was associated with reductions in spending for nontargeted members, a spillover effect.
肿瘤护理模式（OCM）是一种针对患有癌症的传统医疗保险受益人的基于价值的支付模式，其带来的总支出减少被激励性支付所抵消，导致医疗保险和医疗补助服务中心出现净亏损。我们研究了OCM是否在未被该计划纳入目标人群的商业保险参保者和医疗保险优势（MA）成员的总治疗费用、医疗服务利用情况和医疗质量方面产生了溢出效应。
这项观察性研究使用了一家大型全国性支付方的行政索赔数据，共有157,189名患有实体恶性肿瘤的商业保险或MA患者，他们在125家参与OCM的医疗机构（OCM全部医疗机构中的一个子集）以及一组按1:10倾向得分匹配的860家非OCM医疗机构中，于OCM实施前（2012 - 2015年）和实施期间（2016 - 2021年）发起了229,376次全身性抗癌治疗。我们使用差异分析来评估OCM与总治疗费用之间的关联，总治疗费用定义为6个月治疗期间的医疗支出。次要结局包括住院和急诊科（ED）的医疗服务利用情况以及质量指标。
从OCM实施前到实施期间，参与OCM的医疗机构的平均总治疗支付从45,504美元增加到46,239美元，非OCM医疗机构的平均总治疗支付从50,519美元增加到58,591美元（调整后的差异为 - 6,287美元[95%置信区间， - 10,076美元至 - 2,498美元]，P = 0.001）。OCM与高风险（ - 6,756美元[95%置信区间， - 10,731美元至 -
