OBJECTIVES : The Oncology Care Model (OCM) is an episode-based payment model that aims to improve quality of care while reducing costs to Medicare. Participating practices are incentivized by shared savings to keep episodic expenditures below a target price. This study aims to identify factors associated with OCM prostate cancer episode expenditure and episode expenditure exceeding target price.

METHODS : Prostate cancer episodes initiated between 7/1/2016-7/1/2018 were identified in OCM Reconciliation Reports from an NCI-designated cancer center. Clinical information from electronic medical records was linked to each episode for analysis. Multiple linear regression and multiple logistic regression were used to assess factors associated with episode expenditure and episode expenditure exceeding target price, respectively.

RESULTS : Of 302 prostate cancer episodes included in the study from 161 unique patients analyzed, 122 (40.4%) had expenditures exceeding target price. Statistically significant factors positively associated with episodic expenditure include novel therapies (β=$21,013; p<0.0001), inpatient admissions (β=$15,271; p<0.0001), emergency department visits (β=$6,516; p=0.015), skilled nursing facility placement (β=$24,857; p<0.0001), radiation therapy (β=$10,775; p<0.0001), Medicare Part D use (β=$16,920; p<0.0001), and Medicare Part B drug use (β=$18,444; p=0.048). Novel therapies (OR: 3.59; 95% CI: 1.19-10.84), inpatient admission (OR: 10.84; 95% CI: 4.39-26.74), and Part D use (OR: 2.87; 95% CI: 1.52-5.39) were positively associated with episodic expenditure exceeding target price.

CONCLUSIONS : Novel therapies, inpatient admissions, and Part D use were positively associated with both episode expenditure and exceeding target price. Although target price calculation includes adjustments for many factors, there may be opportunities to better calibrate the calculation methodology. Novel therapies are associated with exceeding target price despite being adjusted for in the model. Changing the adjustment for novel therapies may allow the OCM to set more practical target prices by accounting more accurately for the high costs of novel therapies. External validation at other OCM-participating practices is needed to corroborate these results.