Within-practice Medicare spillovers to non-Medicare patients: Evidence from the Oncology Care Model

ABSTRACTObjectives Little is known about whether the Oncology Care Model (OCM) affected care for non-Medicare patients.Study Design The quasi-experimental design here compares participant providers with non-participant providers during the first year of the program compared with the prior year.Methods Relative different levels of office visits and total costs across four cancers – breast, lung, colon, and prostate cancer – are measured for patients with Medicare Advantage, private insurance, and Medicaid and compared with the Medicare population.Results OCM participation is associated with 11.6% fewer Medicare breast cancer visits (estimate = −0.11, 95% CI: −0.20 to −0.01, p = 0.03) and 9.3% fewer Medicaid breast cancer visits (estimate = −0.10, 95% CI: −0.21 to 0.02, p = 0.09). Practices seeing more Medicare patients drive this result; every 10 percentage points more Medicare patients seen by OCM providers correlate with 6.1% fewer Medicaid visits (estimate = −0.66, 95% CI: −1.39 to 0.06, p = 0.07). Some patterns like lower costs did not extend to non-Medicare patients while others absent in Medicare were measured in non-Medicare patients.Conclusions This analysis suggests that care patterns are different under the OCM for both Medicare and non-Medicare lives, but that these differences are modest and inconsistent.KEYWORDS: Oncology Care ModelspilloversMedicaidMedicarebreast cancer AcknowledgementsIn-kind support by way of data were provided to the author by McKesson and The US Oncology Network through the Health Services Research Committee. The author has also received financial support via employment from Tulane University and McKesson, and in-kind data support for other projects from Blue Cross Blue Shield of Louisiana, the Louisiana Department of Health, and McKesson. Otherwise, this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Nicholas Robert, MD, provided helpful feedback used to improve the revision of this manuscript.Disclosure statementNo potential conflict of interest was reported by the author(s).Meeting presentationAn abstract providing perspectives (without magnitudes) on these spillovers can be found at: Walker, Brigham. ‘Early physician spillover responses to the oncology care model.’ (2020): e19393–e19393. https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e19393.Additional informationNotes on contributorsBrigham WalkerBrigham Walker is an Assistant Professor in the Department of Health Policy and Management at the Tulane School of Public Health and Tropical Medicine. His research generally focuses on how providers, payers, and patients behave in response to new information or incentives.