Analysis: Why some participants are likely to leave the Oncology Care Model

Currently CMMI’s Oncology Care Model (OCM) is an upside-only model based on the total cost of care for an episode of cancer treatment. Starting in July, CMS will transition all participants who have not received a performance-based payment (generated “shared savings”) to one of two downside-risk models. One is a downside-only model. 

CMS recently added a risk -based payment model in OCM that includes a neutral corridor. Avalere recently modeled, evaluated and reported on the two options and found approximately 70% of OCM participants will face recoupment (shared loss) under option one. Under option two, approximately 50% of participants will have to repay CMS. 

Takeaway

Like what has been seen with BPCI and BPCI-A, we’re likely to see a number of practices exit the OCM once they face the potential for losses. 

Although factors around the participation decision vary, I would expect to see most participants who have not achieved savings but are in the OCM for strategic reasons to migrate into the option with a neutral corridor. This will allow them to continue gaining experience with risk-based models while minimizing the risk of losses beyond their investments in care management infrastructure and care pathway redesign.

As with other risk-based models, there appears to be data suggesting that the types of cancers a practice treats significantly influences the ability to generate savings, which also will have some bearing on the decision by a practice to continue participating. The more a practice perceives the deck is stacked against them due to their mix of cancer cases, the more likely their exit becomes.