Cancer Care Alternative Payment Model Didn’t Reduce Novel Drug Use

Clinicians participating in alternative payment models must keep a close eye on the cost of care. However, that is not at the expense of novel anticancer drug use in the Oncology Care Model (OCM), a CMS-run cancer care alternative model, according to a recent study.

Healthcare stakeholders have expressed concerns that the OCM may have discouraged the use of novel anticancer therapies because of the alternative payment model’s incentives to reduce overall cancer care spending. Novel therapies tend to be expensive and research had found that the drugs were affecting costs for participating clinicians facing spending targets under the OCM.

OCM participants had to reduce the total costs of care for attributed patients below the spending targets in order to share in savings and receive incentive payments.

Notably, CMS included a novel therapy adjustment to spending targets to offset up to 80 percent of the incremental spending on the use of novel therapies. However, concerns remained.

The retrospective, registry-based cohort study recently published in JAMA Network Open found no association between participation in the OCM and the likelihood of patient receipt of novel therapies across a range of cancer types.

The study linked OCM participation data with Surveillance, Epidemiology, and End Results (SEER) Program data from 2014 through 2018 to identify patients potentially eligible to receive one of 10 novel cancer therapies and determine whether they received the novel therapy or an alternative treatment.

The novel therapies in the study had received US Food and Drug Administration (FDA) approval for a new indication in the 18 months before the OCM’s start on July 1, 2016, and included palbociclib for breast cancer treatment, ramucirumab for colon cancer treatment, nivolumab for melanoma treatment, and alectinib for non-small cell lung cancer treatment.

Patient receipt of the novel therapies had actually increased steadily over time across both OCM-participating practices and non-OCM practices, the study showed.

Patient likelihood of novel therapy receipt increased from 33.2 percent before July 2016 to 40.1 percent after July 2016 among oncologists outside of the alternative payment model and from 39.9 percent to 50.3 percent over the same period for oncologists participating in OCM.

Researchers said the difference-in-differences of 3.5 percentage points was nonsignificant, indicating no real impact on patient receipt of novel therapies in the OCM. In fact, patients treated in OCM-participating practices were more likely to receive novel therapies both before and after implementation of the alternative payment model.

However, they did find that the likelihood of receiving novel therapy for second-line treatment of advanced lung cancer was higher for patients treated at OCM-participating practices compared to non-participating practices. They were 17.4 percentage points more likely to receive the novel drug for that indication.

Additionally, the study found that Black patients were much less likely to receive a novel therapy even though the drugs offer significant improvement in outcomes. A difference-in-differences analysis showed a large increase in the receipt of novel therapies for Black patients treated by oncologists in the OCM, but researchers said the finding was still not significant.

“This finding raises the possibility that the OCM might have helped narrow racial disparities in patient access to novel therapies, which would be a noteworthy advance if it bears out in future research,” researchers wrote in the study.

“The association between payment models and disparities in access to care needs to be incorporated into evaluation of the OCM’s successor model as well as assessments to identify why the payment model has such an association,” they continued.

CMS’ Innovative Center recently revamped its strategy for designing alternative payment models, like the OCM. Advancing health equity is now a pillar of its strategy and will be explicitly addressed in future models.

Researchers also suggested that the study’s results be used to “inform the development and evaluation of cost and use incentives for Medicare’s new Enhancing Oncology Model.”

The Enhancing Oncology Model will launch in the summer of 2023.