Quality of care for dual eligible beneficiaries in the oncology care model

TL;DR

The study found that the Oncology Care Model did not improve care quality for dual eligible cancer patients compared to non-dual eligible patients.

Contribution

This study evaluates the impact of the Oncology Care Model on dual eligible beneficiaries using Medicare claims data.

Findings

OCM participation did not improve healthcare utilization or end-of-life quality for dual eligible beneficiaries.

Dual eligible beneficiaries had higher hospitalization and emergency department use compared to non-dual eligible beneficiaries.

Focused policies may be needed to address disparities in care for dual eligible beneficiaries.

Abstract

Dual eligible beneficiaries are a vulnerable population who often experience inferior access to care and outcomes compared to non‐dual eligible beneficiaries. The Oncology Care Model (OCM) is an alternative payment model that aims to improve coordination and quality of care in beneficiaries receiving chemotherapy and thus may improve care for dual eligible beneficiaries with cancer.

We used 100% Medicare claims data from 2014 through 2019 and included beneficiaries with bladder, breast, esophageal, colorectal, kidney, lung, pancreatic, or prostate cancer receiving chemotherapy. We constructed multivariable difference‐in‐differences regression models to evaluate the effect of OCM participation on healthcare utilization and quality of care at the end‐of‐life among dual eligible beneficiaries. We also compared healthcare utilization and quality of care outcomes to non‐dual eligible beneficiaries.

We identified 3,043,944 episodes of care among 1,260,892 unique Medicare beneficiaries. Ten percent of all beneficiaries (n = 126,758) were dual eligible and 64,087 (22%) of episodes among dual eligible patients were in an OCM participating practice. We noted no effect of OCM participation on healthcare utilization or end‐of‐life quality of care for dual eligible beneficiaries. However, we observed higher rates of hospitalization, emergency department visits, intensive care unit stays, and a lower number of office visits among dual eligible beneficiaries compared to non‐dual eligible beneficiaries.

Participation in OCM was not associated with improvements in quality of care or healthcare utilization for dual eligible beneficiaries. Dual eligible beneficiaries experience lower quality of care across several measures compared to non‐dual eligible beneficiaries. Focused policies and incentives may be necessary to address disparities within emerging health reforms.

Participation in the Oncology Care Model was not associated with improvements in quality or utilization for dual eligible beneficiaries. Dual eligible beneficiaries continue to experience lower quality across several utilization measures compared to non‐dual eligible beneficiaries.

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