{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T17:27:03Z","timestamp":1772731623705,"version":"3.50.1"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Maryland\u2019s Global Budget Revenue (GBR) model provided fixed global payments to hospitals, aiming to control revenue growth while improving care quality. The implications of GBR implementation in 2014 for cancer care have not been robustly evaluated.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between GBR implementation and subsequent changes in episode-based Medicare payments, hospital utilization, and quality of care among Medicare beneficiaries undergoing systemic therapy for cancer.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used a difference-in-differences approach to compare changes in outcome measures from pre-GBR (2011-2013) to post-GBR (2014-2018) implementation periods in Maryland compared with 11 control states. Six-month care episodes were selected for adult fee-for-service Medicare beneficiaries initiating or continuing cytotoxic chemotherapy, immunotherapy, or targeted therapy for cancer between 2011 and 2018. Data were obtained from Medicare claims, including inpatient, outpatient, carrier, durable medical equipment, home health agency, hospice, and Part D event files. All analyses were performed between April 4, 2024, and January 5, 2026.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were standardized Medicare payments during the 6-month systemic therapy episode, including total, hospital, and professional payments. Also assessed were measures of hospital-based utilization (all-cause hospitalizations and emergency department [ED] visits) and care quality (timely receipt of chemotherapy; chemotherapy-related hospitalizations and ED visits; and measures of high-intensity end-of-life treatment: no or late hospice enrollment, &amp;gt;1 ED visit in the last 30 days of life, intensive care unit stay in the last 30 days of life, and receipt of chemotherapy in the last 14 days of life).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 38\u202f531 chemotherapy episodes in Maryland were matched to 38\u202f531 episodes in control states. Episodes in Maryland were for patients (22\u202f185 females [57.6%]) with a mean (SD) age of 73.3 (8.6) years; in control states, episodes were for patients (21\u202f708 females [56.3%]) with a mean (SD) age of 72.7 (9.1) years. GBR implementation was associated with a reduction of $3075 (95% CI, \u2212$4276 to \u2212$1843; 6.1% savings) in total episode payments, a reduction of $3217 (95% CI, \u2212$4058 to \u2212$2328; 17.3% savings) in hospital payments, and an increase of $1382 (95% CI, $781-$2013; 11.9% increase) in professional payments. There was a reduction of 1.7 (95% CI, \u22123.0 to \u22120.5) percentage points in chemotherapy-related hospitalizations. No significant association was found for other hospital-based utilization or care quality measures.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This cohort study of patients with systemic anticancer therapy episodes showed that Maryland\u2019s GBR model was associated with substantial reductions in the growth of Medicare payments. These savings may have been achieved by shifting care toward lower-cost treatment settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0485","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T16:30:55Z","timestamp":1772728255000},"page":"e260485","source":"Crossref","is-referenced-by-count":0,"title":["Global Budget Revenue Model and Care for Patients Receiving Chemotherapy"],"prefix":"10.1001","volume":"9","author":[{"given":"Yu-Li","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley","family":"Herring","sequence":"additional","affiliation":[{"name":"Department of Economics, University of New Hampshire Paul College of Business and Economics, Durham"},{"name":"Department of Health Management and Policy, University of New Hampshire College of Health and Human Services, Durham"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Melamed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Petrillo","sequence":"additional","affiliation":[{"name":"Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy L.","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"II","given":"Anaeze C.","family":"Offodile","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"issue":"1","key":"zoi260036r1","first-page":"10","article-title":"Cancer statistics, 2025.","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"zoi260036r2","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.mayocpiqo.2023.08.005","article-title":"The burden of chronic disease.","volume":"8","author":"Hacker","year":"2024","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"issue":"16","key":"zoi260036r4","doi-asserted-by":"publisher","first-page":"3293","DOI":"10.1002\/cncr.31367","article-title":"Alternative payment and care-delivery models in oncology: a systematic review.","volume":"124","author":"Aviki","year":"2018","journal-title":"Cancer"},{"issue":"18","key":"zoi260036r5","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.1001\/jama.2021.17642","article-title":"Association of participation in the Oncology Care Model with Medicare payments, utilization, care delivery, and quality outcomes.","volume":"326","author":"Keating","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"zoi260036r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.4904","article-title":"A new approach to cancer bundled payments in Medicare-the Enhancing Oncology Model.","volume":"4","author":"Kocher","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"8","key":"zoi260036r9","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1056\/NEJMsb2031138","article-title":"CMS Innovation Center at 10 years - progress and lessons learned.","volume":"384","author":"Smith","year":"2021","journal-title":"N Engl J Med"},{"issue":"6","key":"zoi260036r11","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.1726","article-title":"Transforming specialty care delivery and payment under global budgets-insights from the provision of surgical services in Maryland.","volume":"4","author":"Kadakia","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"7","key":"zoi260036r12","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1001\/jamainternmed.2018.8747","article-title":"Primary care spending in the fee-for-service Medicare population.","volume":"179","author":"Reid","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"10","key":"zoi260036r15","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1377\/hlthaff.2014.0280","article-title":"Acute hospital care is the chief driver of regional spending variation in Medicare patients with advanced cancer.","volume":"33","author":"Brooks","year":"2014","journal-title":"Health Aff (Millwood)"},{"issue":"22","key":"zoi260036r16","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1001\/jama.2014.16153","article-title":"Methods for evaluating changes in health care policy: the difference-in-differences approach.","volume":"312","author":"Dimick","year":"2014","journal-title":"JAMA"},{"issue":"10","key":"zoi260036r17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"issue":"1","key":"zoi260036r19","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1097\/SLA.0000000000006427","article-title":"Maryland\u2019s Global Budget Revenue Payment model and shifts in the surgical site of care among Medicare beneficiaries.","volume":"283","author":"Lin","year":"2026","journal-title":"Ann Surg"},{"issue":"4","key":"zoi260036r20","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1377\/hlthaff.2018.0112","article-title":"Changes in hospital utilization three years into Maryland\u2019s Global Budget Program for rural hospitals.","volume":"37","author":"Roberts","year":"2018","journal-title":"Health Aff (Millwood)"},{"issue":"6","key":"zoi260036r22","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1200\/JCO.2003.03.059","article-title":"Identifying potential indicators of the quality of end-of-life cancer care from administrative data.","volume":"21","author":"Earle","year":"2003","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi260036r23","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1200\/JCO.2004.08.136","article-title":"Trends in the aggressiveness of cancer care near the end of life.","volume":"22","author":"Earle","year":"2004","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi260036r24","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1038\/s41416-020-01038-6","article-title":"Cancer health disparities in racial\/ethnic minorities in the United States.","volume":"124","author":"Zavala","year":"2021","journal-title":"Br J Cancer"},{"issue":"6","key":"zoi260036r25","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1093\/gerona\/glz224","article-title":"Measuring frailty in administrative claims data: comparative performance of four claims-based frailty measures in the U.S. Medicare data.","volume":"75","author":"Kim","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"11","key":"zoi260036r26","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1097\/MLR.0b013e31817925d2","article-title":"Ability of Medicare claims data to identify nursing home patients: a validation study.","volume":"46","author":"Koroukian","year":"2008","journal-title":"Med Care"},{"issue":"2","key":"zoi260036r28","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1097\/MLR.0000000000001243","article-title":"Provider practice competition and adoption of Medicare\u2019s Oncology Care Model.","volume":"58","author":"Jalali","year":"2020","journal-title":"Med Care"},{"issue":"4","key":"zoi260036r30","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1097\/SLA.0000000000005737","article-title":"Is the centralization of complex surgical procedures an unintended spillover effect of global capitation? insights from the Maryland Global Budget Revenue program.","volume":"277","author":"Offodile","year":"2023","journal-title":"Ann Surg"},{"issue":"S1","key":"zoi260036r31","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1111\/1468-0009.12632","article-title":"The next generation of payment reforms for population health: an actionable agenda for 2035 informed by past gains and ongoing lessons.","volume":"101","author":"Kadakia","year":"2023","journal-title":"Milbank Q"},{"issue":"2","key":"zoi260036r35","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1245\/s10434-020-08867-y","article-title":"Improving the quality of cancer care in community hospitals.","volume":"28","author":"Tucker","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"zoi260036r36","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.4920","article-title":"Health care leaders\u2019 perspectives on the Maryland All-Payer Model.","volume":"3","author":"Kilaru","year":"2022","journal-title":"JAMA Health Forum"},{"key":"zoi260036r3","unstructured":"National Cancer Institute. Age and cancer risk. May 2, 2025. Accessed August 3, 2025. https:\/\/www.cancer.gov\/about-cancer\/causes-prevention\/risk\/age"},{"key":"zoi260036r7","unstructured":"Acumen. Evaluation of Maryland Medicare spending on chronic conditions. November 2022. Accessed July 15, 2025. https:\/\/www.crisphealth.org\/wp-content\/uploads\/2023\/02\/2023-01-06-crisp-task4-report-v9-FINAL.pdf"},{"key":"zoi260036r8","unstructured":"The Center for Medicare and Medicaid Innovation. Maryland All-Payer Model. March 2, 2020. Accessed July 15, 2025. https:\/\/innovation.cms.gov\/innovation-models\/maryland-all-payer-model"},{"key":"zoi260036r10","unstructured":"RTI International. Evaluation of the Maryland All-Payer Model, volume I: final report. November 2019. Accessed July 15, 2025. https:\/\/downloads.cms.gov\/files\/md-allpayer-finalevalrpt.pdf"},{"key":"zoi260036r13","unstructured":"Centers for Medicare & Medicaid Services. States advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. October 28, 2024. Accessed August 3, 2025. https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/ahead"},{"key":"zoi260036r14","unstructured":"Roemer? M. Cancer-related hospitalizations for adults, 2017. HCUP Statistical Brief #270. January 2021. Accessed August 3, 2025. https:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb270-Cancer-Hospitalizations-Adults-2017.jsp"},{"key":"zoi260036r18","unstructured":"The Center for Medicare and Medicaid Innovation. Oncology Care Model performance period 3 and forward payment methodology. 2021. Accessed March 20, 2024. https:\/\/innovation.cms.gov\/innovation-models\/oncology-care"},{"key":"zoi260036r21","unstructured":"Centers for Medicare & Medicaid Services. Hospital outpatient quality reporting specifications manual. June 2025. Accessed June 5, 2025. https:\/\/qualitynet.cms.gov\/outpatient\/specifications-manuals"},{"key":"zoi260036r27","unstructured":"Social Deprivation Index (SDI). Robert Graham Center website. Accessed November 1, 2024. https:\/\/www.graham-center.org\/maps-data-tools\/social-deprivation-index.html"},{"key":"zoi260036r29","unstructured":"Office of Pharmacy Affairs 340B OPAIS daily reports. Health Resources and Services Administration. Accessed September 20, 2023. https:\/\/340bopais.hrsa.gov\/Reports"},{"key":"zoi260036r32","unstructured":"Strategic direction. The Center for Medicare and Medicaid Innovation. May 13, 2025. Accessed September 9, 2025. https:\/\/www.cms.gov\/priorities\/innovation\/about\/strategic-direction"},{"key":"zoi260036r33","unstructured":"Evaluation of the Oncology Care Model: final report. Abt Global. May 2024. Accessed August 14, 2025. https:\/\/www.cms.gov\/priorities\/innovation\/data-and-reports\/2024\/ocm-final-eval-report-2024"},{"key":"zoi260036r34","unstructured":"Bringing research to the community to reduce cancer disparities. National Cancer Institute. September 21, 2017. Accessed August 10, 2025. https:\/\/www.cancer.gov\/research\/areas\/disparities\/chanita-hughes-halbert-clinical-trials-community-access"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2845958\/lin_2026_oi_260036_1772473034.93271.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T16:30:58Z","timestamp":1772728258000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2845958"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.0485","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]}}}