Table 4. Association of the OCM With Chemotherapy Use, Quality of Care, and Outcomes.
| Measures | No. of episodes | Mean value | Difference-in-differences estimate (90% CI) | Change, %a | ||||
|---|---|---|---|---|---|---|---|---|
| OCM intervention group | Comparison group | |||||||
| OCM | Comparison | Baseline | Intervention period | Baseline | Intervention period | |||
| No. of Part B novel therapy drug services per episode | ||||||||
| High-risk breast cancer | 88 807 | 90 478 | 0.260 | 0.458 | 0.224 | 0.447 | −0.025 (−0.077 to 0.026) | −9.7 |
| Lung cancer | 91 762 | 100 411 | 0.855 | 3.195 | 0.814 | 3.229 | −0.075 (−0.425 to 0.275) | −8.8 |
| Lymphoma | 60 830 | 60 987 | 0.324 | 0.354 | 0.342 | 0.352 | 0.020 (−0.057 to 0.097) | 6.2 |
| Colorectal cancer | 54 350 | 58 839 | 2.591 | 0.158 | 2.497 | 0.088 | −0.024 (−0.059 to 0.011) | −0.9 |
| Chronic leukemia | 33 674 | 36 219 | 0.320 | 0.047 | 0.283 | −0.001 | 0.010 (−0.005 to 0.025) | 3.2 |
| Episodes with any immunotherapy use, %b | ||||||||
| Lung cancer | 91 762 | 100 411 | 7.6 | 42.9 | 9.2 | 42.0 | 2.5 (0.4 to 4.7) | 33.4 |
| Kidney cancer | 10 616 | 12 365 | 13.3 | 43.6 | 12.2 | 42.6 | −0.1 (−1.8 to 1.5) | −1.1 |
| Melanoma | 9147 | 10 731 | 62.0 | 82.8 | 67.1 | 84.9 | 2.9 (0.9 to 4.9) | 4.6 |
| Episodes with chemotherapy-associated hospitalizations and ED visits, % | ||||||||
| Hospitalizations | 658 102 | 727 671 | 13.5 | 12.4 | 12.9 | 11.9 | −0.1 (−0.3 to 0.2) | −0.4 |
| ED visits | 658 102 | 727 671 | 17.7 | 16.8 | 17.6 | 17.0 | −0.3 (−0.6 to 0.0) | −1.9 |
| Episodes with adjuvant chemotherapy within 60 d of surgery, % | ||||||||
| Breast cancer | 10 651 | 11 530 | 59.6 | 60.8 | 60.2 | 61.8 | −0.5 (−2.5 to 1.6) | −0.8 |
| Colorectal cancer | 12 737 | 13 564 | 73.1 | 72.6 | 75.3 | 73.7 | 1.2 (−0.8 to 3.1) | 1.6 |
| Episodes with specific care at the end of life, % | ||||||||
| Chemotherapy in last 30 d of lifec | 121 699 | 134 403 | 10.0 | 8.9 | 9.7 | 8.6 | 0.0 (−0.3 to 0.4) | 0.4 |
| Any hospitalization in last 30 d of life | 121 699 | 134 403 | 53.5 | 52.2 | 53.7 | 53.5 | −1.1 (−1.9 to −0.4) | −2.1 |
| ≥2 ED visits in last 30 d of life | 121 699 | 134 403 | 15.1 | 15.5 | 15.8 | 16.7 | −0.5 (−1.1 to 0.1) | −3.4 |
| Hospice enrollment ≥3 d before deathd | 121 699 | 134 403 | 58.5 | 59.8 | 59.8 | 58.0 | 0.5 (−0.4 to 1.4) | 0.8 |
| Restricted survival time through 18 mo, de | 116 233 | 125 186 | 427.9 | 433.5 | 430.4 | 438.2 | −2.2 (−4.6 to 0.3) | −0.5 |
Abbreviations: ED, emergency department; OCM, Oncology Care Model.
Percentage change in the difference-in-differences estimate from the OCM baseline value.
Checkpoint inhibitor immunotherapy included atezolizumab, ipilimumab, nivolumab, pembrolizumab, avelumab, durvalumab, and cemiplimab-rwlc.
Part B chemotherapy only.
Contributes to the OCM Performance-Based Payment Quality Score.
Survival was assessed at the beneficiary level from the start of an episode with no episode in the prior year among beneficiaries with 7 types of cancer that have high prevalence and at least moderately high mortality (acute leukemia, chronic leukemia, lymphoma, lung cancer, pancreatic cancer, colorectal cancer, and high-risk breast cancer). Restricted mean survival time is the mean survival time (in days) from the start of an episode through a specified period of time (18 months).