Rewriting the Narrative on the Oncology Care Model

The Oncology Care Model (OCM) was the first Centers for Medicare & Medicaid Services (CMS) alternative payment model in oncology. In this issue of JAMA, Brooks et al report the final evaluation, concluding that the OCM was associated with a relative reduction of $616 per episode in total Medicare payments, excluding Monthly Enhanced Oncology Services (MEOS) and performance-based payments to practices.

Strikingly, savings grew over time, reaching –$1282 per episode in the final performance period, roughly quadrupling the –$297 per-episode reduction reported in the interim 3-year evaluation. Yet the headline will be the net loss to Medicare: between MEOS payments and performance-based payments, the program paid out $639 million more than it gained in spending reductions over 6 years.

This framing that growing spending reductions were insufficient to offset program payments has already shaped policy. The Enhancing Oncology Model (EOM), which launched in July 2023 with significantly less participation than the OCM, was designed to correct the interim evaluation’s net-loss finding.