Healthcare resource utilization, quality metrics, and costs of bladder cancer within the oncology care model.

Abstract

54 Background: The Oncology Care Model (OCM) incentivizes practices to provide higher quality, lower cost care for Medicare beneficiaries through payment arrangements that include financial and performance accountability for 6-month care episodes. We sought to describe the existing experience with bladder cancer (BC) for OCM practices, in the context of all OCM cancer types, given the dynamic treatment landscape in which new and emerging therapies will impact spending and patient care in this payment model. Objective: To estimate healthcare resource utilization (HRU), OCM quality metrics, and costs for OCM episodes among Medicare beneficiaries with BC. Methods: OCM episodes triggered by receipt of cancer therapy (index event) were identified among Medicare beneficiaries (100% Research Identifiable Files) from 2016-18. Other inclusion criteria were enrollment in Parts A & B for the entire OCM episode (6 months or until death) and 6 months pre-index date, Medicare as primary payer, and ≥1 qualifying Evaluation & Management visit during the episode. A cancer type was assigned to each episode. BC episodes were stratified as low- (defined by receipt of BCG and/or mitomycin without other systemic therapy) or high-risk (receipt of systemic therapy other than BCG or mitomycin) based on OCM definitions. Results: Of the 2.2 million OCM cancer episodes identified among 1 million beneficiaries, 60,099 (̃3%) were BC episodes. Our analytic cohort consisted of 43,621 BC episodes (69% low-risk and 31% high-risk) among 33,497 beneficiaries. Across BC episodes, average patient age was 76.6 years and 77% were male. Relative to low-risk episodes, high-risk episodes included higher metastatic cases (40 vs 2%), and more comorbidity burden (7.4 vs 4.3 Charlson comorbidity score). High-risk episodes had more hospital admissions (0.7 vs 0.2) and intensive care unit use (17 vs 5%), longer length of stay (5.9 vs 4.9 days), and higher rates of surgery (7 vs 1%) and mortality (17 vs 2%). Among OCM quality metrics, high-risk episodes had higher inpatient admissions (42 vs 15%) and emergency department visits (37 vs 20%) relative to low-risk episodes. Average spending per high-risk BC episode was ̃$38,000 (vs $9,204 for low-risk), with ̃$11,000 spent on systemic therapies and ̃$7,000 on inpatient services. Conclusions: High-risk OCM episodes of BC, which included 40% metastatic BC, had higher HRU and costs, and lower quality performance, than low-risk episodes. Novel therapies offer a significant opportunity to optimize BC management and improve quality of care, particularly for high-risk episodes. Further, as < 3% of OCM episodes were attributed to BC, and only one-third of BC episodes were classified as high-risk, controlling expenditure on novel therapies in BC episodes is unlikely to impact overall performance for practices participating in OCM.