Sustained Impacts in the Oncology Care Model: Medicare Payment Impacts in the 18 Months After the Model's End

To evaluate whether payment reductions achieved during the Oncology Care Model (OCM) continued after the model ended.

OCM was a voluntary episode-based alternative payment model designed to improve the value of care for Medicare beneficiaries receiving chemotherapy for cancer. Participating practices received $160 monthly care coordination payments and could receive shared savings (or penalties) according to quality and spending goals during 6-month episodes. We extended the OCM regression-adjusted difference-in-differences (DID) payment analysis by 18 months after the model's conclusion to assess sustained effects on total episode payments (TEP) and component Parts A, B, and D, and Part B drug payments.

We used Medicare administrative data, model program data, and secondary sources describing market and provider characteristics to analyze 6-month chemotherapy episodes for Medicare fee-for-service beneficiaries initiated during January 2014-July 2015 (baseline), July 2016-December 2021 (performance), and January 2022-June 2023 (post-performance).

In the 18 months following OCM's end, on average, OCM practices reduced TEP by -$955, driven by significant reductions in Part B payments (-$559). Part B payment reductions were primarily for non-chemotherapy drugs (-$489). Overall payment reductions totaled $328 million. Sustained payment reductions were predominantly among practices adopting two-sided risk; these practices reduced TEP by $3379, including significant reductions in Parts A (-$738), B (-$1370), and D (-$1112) payments.

OCM savings following the model's end were driven by practices that adopted two-sided risk. These sustained payment reductions after OCM's conclusion provided substantial additional savings for CMS, reducing estimated model losses from $639 million to $311 million.