Oncology practices that participated in two-sided danger within the latter half of the Oncology Care Mannequin (OCM) have been the principle driver of cost reductions within the mannequin, in keeping with an analysis ready for the Heart for Medicare & Medicaid Innovation.
In February 2015, the Facilities for Medicare & Medicaid Providers (CMS) invited oncology doctor group practices to take part within the OCM, an alternate cost mannequin based mostly on six-month episodes for most cancers look after Medicare fee-for-service (FFS) beneficiaries present process chemotherapy therapy. The six-year OCM started with six-month chemotherapy therapy episodes, beginning on July 1, 2016, and operated for 11 consecutive six-month efficiency durations (PPs). The final episodes ended on June 30, 2022.
OCM examined whether or not cost reform and healthcare supply redesign can enhance high quality and scale back Medicare spending for sufferers present process chemotherapy for most cancers, by combining attributes of medical properties—patient-centeredness, care coordination, accessibility, evidence-based pointers, and steady high quality enchancment—with monetary incentives for offering companies effectively and with top quality.
This report estimates separate impacts for 5 distinct teams of practices based mostly on their stage of OCM participation, as damaged out by how lengthy they remained within the mannequin and whether or not they ultimately elected a two-sided danger part to their monetary incentive. This contrasts with the Remaining Analysis Report, which aggregated impacts throughout all practices.
Though the report discovered that practices that participated in two-sided danger drove OCM cost reductions, not one of the different 4 teams of practices they analyzed achieved important reductions in complete episode funds.
The report does word that whereas practices that adopted two-sided danger succeeded in decreasing funds for Half A, Half B, and Half D funds, they didn’t scale back the chance of expensive inpatient admissions or emergency division visits, nor did they enhance entry to well timed hospice care on the finish of life.
After accounting for mannequin funds, practices that adopted two-sided danger by the top of the mannequin achieved web financial savings for Medicare in 10 of 11 efficiency durations, totaling $299.6 million. All different practices achieved web Medicare losses in all efficiency durations, with losses largest for practices remaining in one-sided danger.
Practices with two-sided danger additionally earned the very best performance-based funds and have been probably to attain the standard thresholds essential to preserve all performance-based funds, demonstrating that these practices not solely achieved the very best monetary impacts but in addition the very best high quality, on common, the report stated.
Relative to different practices, practices with two-sided danger have been extra prone to be impartial of a hospital or well being system, on common, though the report authors stress that these outcomes don’t suggest this was a crucial situation for achievement. These practices additionally stood out within the extent to which they expanded or carried out modifications in care processes in response to the mannequin.
A small variety of practices terminated their participation after the primary 12 months of the mannequin, with 4 practices leaving. within the latter half of 2018 and a complete of 27 practices leaving OCM by the center of 2019. Mannequin exit accelerated at first of 2020 with the introduction of obligatory two-sided danger for practices that had not achieved performance-based funds within the first two mannequin years: general, 37 further practices exited the mannequin within the second half of 2019. Exit interviews and surveys steered that practices that exited by mid-2019 primarily terminated as a consequence of problem assembly mannequin necessities, whereas most terminations occurring after mid-2019 have been primarily as a consequence of considerations associated to two-sided danger.
The authors additionally stress that the outcomes can’t distinguish whether or not adoption of two-sided danger within the final two to a few mannequin years enhanced efficiency or was merely correlated with improved efficiency. Practices that finally elected to take part in two-sided danger contracts confirmed proof of better OCM impacts than comparability practices beginning within the first efficiency interval, suggesting that these higher-performing practices had extra confidence they might reach two-sided danger preparations. Nevertheless, though impacts elevated after the adoption of two-sided danger, the the authors stated they can not rule out the likelihood that the extra incentives of two-sided danger spurred practices to attain better impacts than they might have remaining underneath one-sided danger.
Whether or not or not adoption of two-sided danger led to higher efficiency, the authors counsel that cost impacts generated by practices that did undertake two-sided danger show that episode-based oncology fashions have the potential to yield web financial savings for Medicare.
The follow-on program to OCM is the Enhancing Oncology Mannequin. EOM is a voluntary cost mannequin supposed to rework look after most cancers sufferers. EOM goals to enhance care coordination, high quality, and well being outcomes for sufferers whereas additionally holding oncology practices accountable for complete prices of care to make most cancers care extra inexpensive, equitable, and accessible for sufferers and Medicare. There are 41 practices and three payers collaborating within the first cohort.
On Might 30, CMS introduced the opening of a second spherical of purposes to affix the EOM in July 2025.
