Oncology Analytics: Treatment Protocol Outcomes, OCM Performance, and Drug Cost Tracking

Oncology practices have the most complex drug cost analytics in medicine. A single chemotherapy regimen — FOLFOX for colorectal cancer, R-CHOP for diffuse large B-cell lymphoma, pembrolizumab-based immunotherapy for lung cancer — can cost $8,000-$25,000 per cycle with infusion administration costs on top. Drug costs typically represent 50-70% of total practice revenue and total practice expense. A practice that doesn't track drug cost per episode by regimen and tumor type has no way to evaluate whether its treatment selection patterns are financially sustainable or whether biosimilar opportunities are being systematically missed.

The Oncology Care Model (OCM) — the primary CMS alternative payment model for oncology — evaluates practices on 6-month episode total cost of care for Medicare beneficiaries receiving chemotherapy. OCM performance hinges on understanding which diagnoses and which treatment regimens drive the highest episode costs, which patients are at risk of ED visits and hospitalizations during chemotherapy, and whether the practice's quality performance on IOM-recommended measures (patient experience, care coordination, clinical appropriateness) is adequate to achieve shared savings. Most OCM participants don't have analytics that can answer these questions within the episode window.

340B drug program savings are largest in oncology among all specialty types. A 340B-enrolled oncology practice can generate $100K-$2M+ annually in drug cost savings by purchasing chemotherapy at 340B acquisition cost and billing at standard reimbursement rates. But calculating 340B savings and tracking 340B compliance (patient eligibility, qualifying encounter documentation) requires analytics that most oncology practices don't have systematically configured.

The Oncology Care Model (OCM) — active through 2026 — is the primary CMS alternative payment model for oncology, covering 6-month chemotherapy episodes for Medicare beneficiaries. OCM practices must achieve a minimum quality performance threshold to be eligible for shared savings payments, with quality measured across IOM domains: communication and care coordination, patient experience, clinical appropriateness, and end-of-life care quality. OCM participation determines 2026 alternative payment model eligibility requirements for oncology practices.

MIPS quality measures for oncology include chemotherapy-specific measures: medical and radiation oncology — 12-month follow-up, adjuvant chemotherapy plan for stage III colon cancer patients, and plan of care for patients with metastatic disease. The Commission on Cancer (CoC) accreditation requires cancer registry data, treatment adherence monitoring, and survivorship care plan documentation — a separate quality reporting framework that overlaps with but does not duplicate OCM or MIPS requirements.