Assessing episode groupers impacting cost and quality comparisons in the Enhancing Oncology Model.

90 Background: The Enhancing Oncology Model (EOM) is an oncology alternative payment model that assesses participating physician group practices’ performance on the total cost of care (TCOC) spend for 6-month episodes of care for seven cancer types, against a predicted benchmark price. The EOM uses a cancer-type based episode grouper with generic covariates (like age, gender, comorbidities, etc.). Episode groupers are intended to systematically group patients’ care journeys into clinically meaningful “episodes”, enabling comparison of heterogeneity, quality and cost for a health condition or disease. We evaluated the precision of episode groupers used in the EOM. Methods: Using EOM performance period 1 episodic and claims data from a large, multi-state, community-based oncology practice network between July 2023 to June 2024, we calculated and compared the measures of central dispersion for each cancer type and cancer type x clinical adjuster combinations where available. Results: These measures of dispersion for each cancer type indicate significant heterogeneity of actual episode costs within each cancer type. Incorporating clinical factors, such as metastatic status for breast, lung and colorectal cancers, and/or HER2 status for breast cancer into the episode grouping methodology only modestly reduces the degree of variability in episode expenditures. Conclusions: Current EOM episode groupers do not capture the heterogeneity of case mix (mix of different disease types within a cancer-type) within each cancer type. Episode groupers employing treatment pathway specific clinical variations of each cancer type may produce more clinically meaningful episodes for comparison of quality and cost. Measures of central dispersion for EOM episodes by cancer type and clinical adjusters. Per Episode TCOC by Cancer Type (in thousands) Cancer Type Average Median Mean Absolute Deviation Standard Deviation Interdecile range Interquartile range Breast 45.6 36.0 29.7 34.1 108.0 58.5 Metastatic, HER2- 36.1 27.1 27.5 76.3 35.8 Metastatic, HER2+ 49.9 57.0 30.5 87.3 46.9 Non-Metastatic, HER2- 44.6 32.2 32.8 97.1 58.1 Non-Metastatic, HER2+ 47.3 37.9 36.8 112.9 62.5 Chronic Leukemia 62.1 66.4 31.0 35.9 114.0 56.3 Lung 71.9 76.2 27.4 33.2 116.6 46.6 Metastatic 76.2 82.2 33.3 116.5 44.6 Non-Metastatic 64.3 65.3 31.7 103.9 44.6 Lymphoma 42.3 31.3 27.5 34.8 100.3 43.6 Multiple Myeloma 93.6 89.1 47.5 57.2 189.9 81.9