Analysis: Cancer type can make a difference in performance of 'bundled' care models

Doctor with inpatient
Performance in bundled payments for cancer care may depend on the type of cancer, according to a new study. (Getty/Ridofranz)

Providers participating in a bundled payment model for cancer care may perform better depending on the type of cancer they’re treating, according to a new report. 

Researchers at Avalere Health analyzed more than 1.9 million episodes of care under one such voluntary model—the Oncology Care Model (OCM)—launched in 2016 by the Center for Medicare and Medicaid Innovation and one of the first physician-led advanced models. 

While actual costs across the model were on par with predicted costs, Avalere researchers found that costs were notably higher for some specific types of cancer. In lung and liver cancer episodes, for example, costs were 8% above what was predicted. 

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The converse was also true, as for some types of cancer costs were lower than anticipated. For bladder cancer and female genitourinary tract cancers, excluding ovarian cancer, costs were 3% lower. 

Richard Kane, senior director of policy modeling and strategy at Avalere and one of the report’s authors, told FierceHealthcare that it was not surprising to the team to see that variation. 

RELATED: CMMI director—Home visits could be focus of upcoming Medicare demos 

“It’s not surprising that it would vary,” Kane said. “But how much would it vary, or what would it vary by? A risk adjustment model is not going to predict every condition’s medical cost accurately.” 

However, he said, because the costs were overall in line with benchmarks set by the Centers for Medicare & Medicaid Services, it’s a sign that CMS should “keep doing what it has been doing.” The agency has responded to concerns from providers and adjusted the model throughout the early demonstration, Kane said. 

Avalere’s report also looks at how providers performed on claims-based quality measures across the spectrum of cancers included in the OCM. Much like with cost, performance varied across types of cancers, though overall the program earned a 92% aggregate score across those quality measures. 

The OCM includes 12 measures, three of which are claims-based. For bladder cancer, scores were also at 92% on average, while for acute leukemia or head-and-neck cancers, zero points were scored on average. 

RELATED: Bundled payments drive hospitals to reduce referrals to SNFs, improve coordination, study finds 

Kane said that since the program is voluntary, the providers who are participating all want to be there and are working together to learn what’s good and what’s bad about the current approach. However, a mandatory bundle offers a greater breadth of data to study, he said. 

Under the Trump administration, CMS ended mandatory bundles for hip replacement and cardiac care late last year, after delaying the bundles multiple times, but it has created new voluntary ones.

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