Evaluation of the Oncology Care Model: Performance Periods 1-9

This interim report covers the first nine out of 11 total performance periods of the Centers for Medicare & Medicaid Services’ Oncology Care Model (OCM). Started in 2016, OCM tested whether financial incentives can improve quality and reduce Medicare spending for Medicare fee-for-service beneficiaries with cancer who are undergoing chemotherapy treatment. OCM paired attributes of medical homes (patient-centeredness, care coordination, accessibility, evidence-based guidelines, and continuous quality improvement) with financial incentives for providing services efficiently and with high quality. Under the model, practices could bill Medicare for additional money on a monthly basis to support care improvements. Practices also could earn money in the form of performance-based payments (PBPs) if they met OCM cost and quality goals.

Findings from this report include:

• OCM was active in 202 practices across 33 states, covering roughly 1 in 4 Medicare patients receiving chemotherapy.
• OCM reduced Medicare payments made for patients undergoing chemotherapy by roughly 1.7 percent relative to a comparison group, driven by payment reductions among several higher-risk cancer types.
• OCM increased use of higher-value (more cost-conscious) supportive care drugs that treat chemotherapy side effects, which generated nearly half of all spending reductions.
• Despite gross reductions in Medicare payments, PBPs and monthly payments to participants exceeded those reductions, resulting in a net loss to Medicare after accounting for incentive payments made to participating oncology practices.
• CMS' new Enhancing Oncology Model focuses on higher-risk cancer types and embeds equity into model design, offering the promise of increased quality and net Medicare savings.