OBJECTIVES

The Oncology Care Model (OCM) is an advanced payment model that aims to improve the quality of oncology care and reduce costs. For participating practices to achieve shared savings, total episode expenditure must fall below set target prices. The purpose of this study was to identify possible predictors of OCM breast cancer (BC) episode expenditure and factors associated with exceeding target price.

METHODS

The study utilized electronic medical record and OCM performance data to capture BC episodes that were initiated between 7/1/2016-7/1/2018, in which patients remained alive for the duration of the episode. Episodes without cancer stage were excluded from the analysis. Multiple linear regression was used to identify factors that significantly increase episode expenditure, and multiple logistic regression was used to identify factors associated with exceeding target price.

RESULTS

There were 526 episodes from 278 unique patients analyzed, of which 189 (35.9%) episodes exceeded target price. Most were stage I (43.4%), followed by stage IV (27%), stage II (23.6%), and stage III (6.1%). Novel therapies (β=$26,617), inpatient admissions (β=$10,246), stage IV (β=$20,824; compared with stage I), and stage II (β=$4,238; compared with stage I) were all significantly associated (p<0.05) with increasing episode expenditure. Novel therapies (OR:20.92, 95%CI:66.59), inpatient admissions (OR:6.89, 95%CI:3.34-14.22), stage IV (OR:2.45, 95%CI:1.26-4.75; compared with stage I), and stage II (OR:1.84, 95%CI:1.06-3.21; compared with stage I) were also associated with exceeding target price.

CONCLUSIONS

Novel therapies, inpatient admissions, and advanced stage were positively associated with increasing episode expenditure and also exceeding target price. Currently, the OCM adjusts target price for novel therapies, but inpatient admissions and staging are not included in the calculation or adjustment. Further adjusting for novel therapies and including adjustments for inpatient admissions and advanced stage cancer may improve target price calculation methods. External validation at other OCM-participating practices is warranted to confirm these results.