Treatment plans derived under the Oncology Care Model (OCM) improved performance on some quality measures and patient-reported outcomes, according to a study performed at three cancer centers.
Physicians and care teams at the University of Alabama, Birmingham; University of South Alabama, Monroeville; and AtlantiCare Cancer Care Institute, Egg Harbor Township, N.J., applied for participation in the Oncology Care Model introduced by the Centers for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation.
“The goal of OCM is to utilize appropriately aligned financial incentives to enable improved care coordination, appropriateness of care, and access to care for beneficiaries undergoing chemotherapy,” according to CMS. “OCM encourages participating practices to improve care and lower costs through an episode-based payment model that financially incentivizes high-quality, coordinated care.”
Lead author Gabrielle Rocque, MD, assistant professor at the University of Alabama, Birmingham, noted that “these three cancer centers believed that leveraging the OCM requirement of treatment plan delivery would create an opportunity to improve care quality.”
They found that “implementation of OCM [treatment plans] has provided an opportunity to improve performance quality measures,” the authors concluded.
The project engaged 33 clinical providers and 171 women with breast cancer. The intervention group included 74 women aged 18 years and older with stage I to III breast cancer who were either planning on or already receiving chemotherapy; they were compared with a historical control group of 86 patients who received chemotherapy (J Oncol Pract. 2019. doi: 10.1200/JOP.18.00390).
Clinical providers engaged in self-study CME courses on quality standards relevant to human epidermal growth factor receptor 2 (HER2)–positive breast cancer and on psychosocial distress, then prepared patient treatment plans including patient-reported outcomes surveys that were connected to the clinical data platform. Fifteen American Society of Clinical Oncology Quality Oncology Practice Initiative measures were selected to compare the treatment and outcomes of the intervention and control groups.
“Statistically significant differences were found on nine measures, with performance higher among those in the intervention group,” Dr. Rocque and her colleagues noted. “Responses to questions that pertained to management of pain, emotional distress, and documentation of advanced directives had the greatest difference.” The areas that showed improvement aligned with indications linked to performance-based payments.
The study has several limitations. AtlantiCare Cancer Care Institute transitioned from a research phase to standard of care after 12 patients, altering the desired accrual of patients for the study. Additionally, “the quality improvement driver is not known because no manner existed to discern differences on the basis of documentation versus change in practice,” the investigators wrote.
That being said, the study authors stated that “the incorporation of technology solutions to meet requirements for participation in payment reform initiatives may provide a platform to effect patient outcomes.”
The study was supported by grants from the American Cancer Society and Genentech. Dr. Rocque reported support from Genentech and Pfizer.
SOURCE: Rocque G et al. J Oncol Pract. 2019. doi: 10.1200/JOP.18.00390.