Hematologic Malignancy Episodes Exceed Target Price in Oncology Care Model

Area of Science:

• Oncology
• Health Economics
• Healthcare Policy

Background:

• The Oncology Care Model (OCM) aims to improve cancer care quality and reduce costs.
• Understanding cost drivers and target price alignment is crucial for OCM success, particularly in hematologic malignancies.

Purpose of the Study:

• To evaluate the alignment between total cost of care (TCOC) and target price in OCM hematologic malignancy episodes.
• To identify factors associated with episodes exceeding the target price.

Main Methods:

• Analysis of hematologic malignancy episodes from OCM performance periods 1-4 reconciliation reports at a large academic medical center.
• Statistical analysis to identify episode characteristics associated with exceeding target price.

Main Results:

• Over half (54.8%) of the 516 analyzed hematologic malignancy episodes exceeded their target price.
• Key factors associated with exceeding target price included Medicare Part B and Part D drug use, novel therapy use, home health agency involvement, and longer duration since last chemotherapy (>730 days).
• The mean TCOC for episodes exceeding target price was significantly higher ($85,374) than the mean target price ($56,106).

Conclusions:

• A substantial misalignment exists between TCOC and target price for hematologic malignancy episodes within the OCM.
• This misalignment suggests potential inadequacies in the OCM target price adjustments for these complex patient populations.