Dramatic changes are occurring as health care evolves into value-based care, bringing a focus on quality. The US Oncology Network (The Network)— one of the nation’s largest networks of integrated, community-based oncology practices—plays a pivotal role in this transformation. The Network, supported by McKesson, is dedicated to advancing evidence-based, patient-centered care through innovative quality measures and comprehensive support services. The use of patient-reported outcome measures—the gold standard in quality measurement—is crucial to building a patient-centered, value-based care system.

Historically, health care has relied on clinically focused quality measures to check whether an activity thought to improve care was completed. However, the activity does not necessarily result in definitive improvement. Now health care is transitioning to a more holistic approach, with a goal of not only managing disease but also identifying and resolving health-related social needs (HRSNs) that can negatively affect care. The care team plays a key role in helping patients address HRSNs, but there has not been a systematic way to capture and analyze data and follow through to confirm issues were alleviated or resolved.

Patient-reported measures addressing HRSNs can play a vital role in transforming health care to a new, higher level of care focusing on the whole person. McKesson, in collaboration with The Network, which has more than 2600 providers and 600 sites of care across the US,

 is committed to advancing health care with a more holistic approach by developing a patient-reported quality measure. The goal is not only to identify patients’ HRSNs but also to assess whether those needs were addressed and/or resolved and if improvements were seen. A closer look at HRSNs, as well as a glimpse at McKesson’s new measure, may provide insight into why these types of quality measures are essential if value-based care is to succeed.

HRSNs are defined as social and economic needs patients experience that affect their ability to maintain their health and well-being. This can include impacts on adherence to treatment plans or access to health care services and needs such as housing, food, personal safety, transportation, and affordable utilities.

When problems arise in these areas, patients may face challenges obtaining care or completing treatment. Helping patients overcome these hurdles enables them to focus on their treatment, which supports optimal outcomes and increases access to care. Research also demonstrates outcomes and health equity improve when patients’ needs, such as screening, are met.

 Marginalized populations are disproportionately affected by HRSNs, leading to health disparities.

 Clinicians can help reduce inequities with interventions such as support services, or they can connect patients with resources, helping to create more equitable outcomes.

Proactively addressing HRSNs can also create cost savings. Emergency department visits and hospital admissions caused by complications from unmet social needs can be reduced. Additionally, savings may occur through investments in interventions promoting preventive care and better disease management.

Patient feedback is an important component of health care that can be used to measure quality of care.

 Patient-reported outcome measures are an efficient way to aggregate information from patients into a valid measure of performance, making this a valuable tool for assessing interventions. Patients tend to be more forthcoming when reporting information themselves, providing a more accurate picture of their situation and enabling providers to personalize interventions. When care team members work with patients to identify a need and provide support and/or resources, patients feel their concerns are acknowledged. This often enhances the relationship and patients’ confidence in their care team.

Significant value for patients with cancer can be achieved from measures that strive to resolve or improve HRSNs, as patients often face difficult challenges, including financial issues, emotional distress, isolation, and limited support services. Outcomes and quality of life can be positively affected by addressing these needs.

Patients’ perspectives and experiences collected by patient-reported measures empower a holistic assessment, drive patient-centered care, and support monitoring of treatment outcomes. Evidence shows that the integration of patient-reported outcome measures into routine clinical practice can improve symptom management, quality of life, and satisfaction for patients.

 Consequently, as health care evolves, incorporating patient-reported outcome measures will be vital in addressing needs and improving the overall well-being of patients.

New Measure Examines Whether Needs Are Met

McKesson’s Patient-Reported Outcomes-Based Performance Measure (PRO-PM)—aimed at improving or resolving HRSNs—is the latest step in the organization’s commitment to develop meaningful, oncology-specific measures that drive improvements in care while streamlining participation in the Merit-based Incentive Payment System (MIPS). Designated by the Centers for Medicare & Medicaid Services (CMS) as a qualified clinical data registry (QCDR), for the past 8 consecutive years McKesson has been certified to develop custom quality measures that are impactful to oncology. With the company’s CMS-approved QCDR platform, Practice Insights, clinicians can participate in the MIPS program by using both MIPS and custom QCDR quality measures that are more specific and meaningful to oncology.

The new HRSNs measure from McKesson is unique. It will be the first patient-reported outcome quality measure available to oncologists and all practices participating in MIPS that examines whether practices achieved improvement or resolution of an HRSN noted by the patient and documented in the medical record. The goal is to have the measure approved by CMS for the 2025 MIPS program.

There are several reasons why the measure is important. First, it examines outcomes rather than processes, reporting on whether an improvement occurred. Secondly, it focuses on addressing HRSNs recognized as highly important to patient care, especially in oncology. When needs are met, patients are more likely to achieve better outcomes and experiences.

The process to develop the measure was carefully planned and executed using input from many angles. The Network’s extensive clinical experts and its frontline experience in patient care were instrumental in shaping the measure, ensuring it will be meaningful, comprehensive, and feasible to implement. A multidisciplinary workgroup was formed that included subject matter and technology experts, plus clinical staff from The Network. Feedback was gathered from patient navigators, social workers, and a physician steering committee within The Network to ensure the measure would be practical in the real world. Measure development can take a long time, but due to the wide range of experts within McKesson and the clinical expertise of The Network, specifications were developed within a few months, and the measure is planned for release in early 2025.

Social workers, navigators, and nurses within The Network have been gathering information on HRSNs for years and helping patients remove barriers to care, but they’ve received little recognition for their valuable contributions. What was done for years in the background by these dedicated professionals will now be brought to the forefront. With McKesson’s PRO-PM, there will be a systematic way to capture HRSN information, address it, track improvements, and then report on the progress or gaps in care.

The education and expertise of the care team— especially social workers—empower them with skills to build a strong relationship with patients. Therefore, they are ideally suited to influence patient care and address patient HRSNs. These experienced communicators help patients identify barriers that are inhibiting care, and they work with patients to navigate those issues. As patient advocates, they also help clinicians understand the patient’s right to self-determination when care recommendations differ from the patient’s choice.

Although the care team has always identified and worked to resolve HRSNs, the challenge now is the massive volume they face. In the past, they received referrals or identified patients on their own. Today all patients are screened, so promptly addressing everyone’s needs has become difficult.

Additionally, there are needs that cannot be met, since different communities have different resources. It is important for practices to strive for high performance in these outcome measures to show improvement, but it is equally important to identify where there are shortages, limitations, or inabilities to meet patients’ needs. A quality measure such as McKesson’s will identify regions unable to show improvements due to lack of resources.

Other quality measures screen for HRSNs, but McKesson’s is the first submitted to CMS for approval that addresses the ability to resolve issues after they have been identified. Feedback from clinical staff indicates they appreciate being able to determine whether patient needs were met. McKesson’s measure moves the needle, allowing clinicians to not only identify needs, but efficiently follow through, capture information, and report on results.

McKesson’s support of The Network, which serves more than 1.4 million patients with cancer annually, brings together experts in technology development with those in the clinical space, creating the ideal scenario for quality measure development. Both are committed to advancing cancer care in this new era of managing HRSNs. McKesson’s new quality measure is the first of many more to come aimed at meeting patients’ needs, ultimately improving outcomes and reducing health care inequities. 

Accelerating the use of patient-reported quality measures in value-based care. Health Care Transformation Task Force. Accessed July 24, 2024. https://hcttf.org/wp-content/uploads/2023/11/Accelerating-the-Use-of-Patient-Reported-Quality-Measures-in-Value-Based-Care.pdf

. May 7, 2024. Accessed July 25, 2024. https://s24.q4cdn.com/128197368/files/doc_financials/2024/q4/MCK-Q4-FY24-Earnings-Call-Transcript.pdf

Addressing health related social needs in communities across the nation. US Department of Health and Human Services. November 2023. Accessed July 25, 2024. https://aspe.hhs.gov/sites/default/files/documents/3e2f6140d0087435cc6832bf8cf32618/hhs-call-to-action-health-related-social-needs.pdf

Patient navigation services increase cancer screening and advance health equity. US Department of Health and Human Services. Updated June 2024. Accessed July 25, 2025. https://health.gov/healthypeople/tools-action/browse-evidence-based-resources/patient-navigation-services-increase-cancer-screening-and-advance-health-equity

Health care access and quality: evidence-based resources. US Department of Health and Human Services. Accessed July 25, 2025. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/evidence-based-resources

Baah FO, Teitelman AM, Riegel B. Marginalization: conceptualizing patient vulnerabilities in the framework of social determinants of health–an integrative review. 

. 2019;26(1):e12268. doi:10.1111/nin.12268

Graboyes EM, Lee SC, Lindau ST, et al. Interventions addressing health-related social needs among patients with cancer. 

. 2024;116(4):497-505. doi:10.1093/jnci/djad269

Patient-reported outcome measures. CMS.gov. December 2023. Accessed July 26, 2024. https://mmshub.cms.gov/sites/default/files/Patient-Reported-Outcome-Measures.pdf

Valsangkar N, Fernandez F, Khullar O. Patient reported outcomes: integration into clinical practices. 

. 2020;12(11):6940-6946. doi:10.21037/jtd.2020.03.91

McKesson’s practice insights designated as a 2024 qualified clinical data registry by Centers for Medicare & Medicaid Services. McKesson. February 8, 2024. Accessed August 8, 2024. https://www.mckesson.com/about-mckesson/newsroom/press-releases/2024/mckessons-practice-insights-designated-2024-qualified-clinical-data-registry-centers-medicare-medicaid-services/

Articles

The transition to value-based care emphasizes quality and patient-centered approaches, with The US Oncology Network playing a crucial role. McKesson, in collaboration with The Network, is advancing patient-reported outcome measures to address health-related social needs (HRSNs), which impact patient outcomes and costs. The new Patient-Reported Outcomes-Based Performance Measure (PRO-PM) aims to improve or resolve HRSNs, focusing on outcomes rather than processes. This measure, developed with input from clinical experts, will be the first of its kind for oncologists participating in the Merit-based Incentive Payment System (MIPS).

The use of patient-reported outcome measures—the gold standard in quality measurement—is crucial to building a patient-centered, value-based care system.

McKesson's Patient-Reported Outcomes Measure Will Track Improvements in Health-Related Social Needs

The paradigm shift in reimbursement to value-based care and mandatory quality data reporting presents new challenges for community oncology practices. Specifically, many clinicians now participate in the Centers for Medicare & Medicaid Services (CMS) Oncology Care Model (OCM), other alternative payment models (APMs), and the Merit-based Incentive Payment System (MIPS). These all tie payments directly to efficient use of healthcare dollars and improvements in patient care.

Many commercial payers have gravitated toward payment models that reflect this new emphasis on value-based care and require data demonstrating high-quality patient care and cost reduction. To ease the administrative burden, CMS has facilitated the collection and processing of information by allowing the formulation of Qualified Clinical Data Registries (QCDRs), which collect data on quality measures from individual providers and group practitioners and transfer this information to CMS. This helps practices to satisfy MIPS requirements for quality and value improvement.

Various organizations have been designated as QCDRs in response to this need for information that shows how well providers are meeting quality and value standards, which CMS uses to determine financial rewards and penalties.

The Evolution of a Qualified Clinical Data Registry

For the MIPS program, CMS allows providers to submit data through a variety of mechanisms in addition to QCDRs. These avenues include claims-based submission, direct electronic health record (EHR) submission, and CMS Web interface data submission. However, QCDRs have a significant advantage over these alternative methods.

In 2017, McKesson Specialty Health launched a full, end-to-end solution for quality measure reporting and MIPS data submission directly to CMS, achieving designation as a QCDR. McKesson’s is one of the few oncology-specific QCDRs. This gives McKesson, in collaboration with providers in The US Oncology Network, the ability to develop custom quality measures that are clinically relevant, improve patient care, and reduce unnecessary healthcare expenditures.

The technological foundation for McKesson’s QCDR is Practice Insights, a reporting platform fully integrated with McKesson’s oncology-specific iKnowMedSM EHR technology. The Practice Insights QCDR enables practices to capture and report on MIPS measures by leveraging the clinical data contained within iKnowMed.

A Tailored Solution for Community Oncology Practices

MIPS quality measures and additional reporting metrics for the OCM and other valuebased care initiatives are supported through the reporting platform, and MIPS data are submitted directly to CMS, without the need for a separate registry vendor. This streamlines data submission and minimizes the need for additional administrative resources, both of which are important for oncology practices seeking to participate successfully in the MIPS program. Several QCDRs, including McKesson’s, support data capture and submission for all 3 MIPS practice-reported categories for 2018: Quality, Advancing Care Information, and Improvement Activities.

Generally, quality measures included in MIPS are broad based and do not address specialtyspecific concerns. QCDRs differ from qualified registries because they do not limit practices to MIPS measures. Often QCDR-developed measures are more specific and relevant to areas of medicine. The support and expertise of physicians, specialty societies, and other healthcare organizations are used to help identify opportunities for quality or cost-of-care improvements and to define specifications for monitoring performance trends. If approved by CMS, these custom-targeted measures can be leveraged for use in the MIPS program.

For example, in 2018 the Practice Insights QCDR includes both MIPS and custom non-MIPS quality measures designed to drive improvements and reduce the cost of cancer care. Specific to the MIPS program, clinicians are required to submit data on only 6 quality measures; however, the Practice Insights QCDR supports an inventory of 20 MIPS and custom oncology-specific measures, providing clinicians with the opportunity to select their top 6 measures to submit for MIPS scoring from a variety of measures they may feel are clinically relevant to the way they practice medicine. Measures of quality and value submitted through QCDRs are closely examined for relevance (

The iKnowMed technology was recently ONC-ACB 2015 Edition certified, a designation that makes providers eligible for 10 MIPS bonus points if they use the 2015 edition exclusively. The points that practices earn for data submission enable them to improve the quality scores they receive from CMS.

In the future, McKesson intends to continue to identify areas in oncology that drive patient engagement and improve patient outcomes. Ultimately, the QCDR will house an inventory of oncology-specific measures that align with a variety of value-based care programs— beyond MIPS and the OCM&mdash;to aid practices in achieving their program- or payer-specific reporting needs.

Erin Crum, MPH is the director of Quality Reporting for McKesson Specialty Health.

To ease the administrative burden, CMS has facilitated the collection and processing of information by allowing the formulation of Qualified Clinical Data Registries, which collect data on quality measures from individual providers and group practitioners. 

Qualified Clinical Data Registries Help Practices Meet MIPS Requirements

Nearly a decade ago, CMS started healthcare providers on the road to value-based care. Along the way, we have seen a variety of quality programs that impact community oncologists, including the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VBM) program, and the Meaningful Use (MU) initiative. Although these programs have moved us along the trajectory from the traditional pay-for-reporting payment model to a pay-for-performance payment model, nothing has shown as much promise to impact the way we reward comprehensive patient care as CMS’ latest proposal, the Quality Payment Program, created by the Medicare Access and CHIP Reauthorization Act of 2015. Whether it proves to be the Utopia of value-based care is debatable, but we have embarked on a new era of healthcare reform and providers should take action now to ensure future success.

The new Quality Payment Program comprises two arms: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models. Through MIPS, Medicare aims to consolidate the PQRS, VBM and MU programs under one umbrella and introduce a new element, Clinical Practice Improvement Activities (CPIAs). Providers will receive points in each of the four categories, and these points will be rolled into one composite score that determines whether the provider receives an incentive or a penalty on future Medicare reimbursement after the reporting year has ended. Although the majority of all Medicare providers will be subject to the requirements of the MIPS program, there is an opportunity to be “MIPS-exempt” by participating in Advanced APMs if they meet specific program criteria.

OCM Practices and Other APMs Have Options

MIPS is a budget-neutral program with stricter reporting requirements than we’ve seen with past programs. Long gone are the days when practices could ignore these programs and feel little financial impact. Although CMS recently announced a phased-in approach for MIPS in 2017, it is important to start working on strategies now to help providers thrive in this new environment.

Many community oncology practices—including 80% of physicians in The US Oncology Network&mdash;are participating in the CMS Oncology Care Model (OCM), which launched in July. Although the OCM is a recognized Alternative Payment Model (APM), it will not qualify as an Advanced APM track until 2018. If practices choose this option to become an Advanced APM with two-sided risk, they would be MIPS-exempt, as well as be eligible for an additional 5% bonus payment from CMS. However, along with this comes the burden to achieve cost savings and show improved patient outcomes or suffer the consequences of having to pay money back to CMS. Many OCM providers are expected to stay in the one-sided risk model. Although this means these practices will be subject to MIPS, many of the core MIPS activities will be either waived or achieved through their OCM participation. Furthermore, these quasi-APMs could be well positioned to benefit from both MIPS incentives and the upside opportunity to receive a shared portion of cost savings through the OCM program.

Unlike MIPS incentives, Advanced APMs are not budgetneutral and offer an opportunity to effectively drive cost savings to our healthcare system, while, at the same time, rewarding practices for making process improvements to impact patient-centered care. Although CMS intended to spur involvement in Advanced APMs beginning in 2017, when providers would participate in a risk-bearing system, there are very few programs that are truly Advanced APMs. It is estimated that less than 10% of all Medicare providers will be eligible to participate in an Advanced APM in 2017. This creates an unusual situation, since many APMs, like the OCM and Medicare Shared Savings Programs (Track 1), do not have two-sided risk.

MIPS Providers Will See Increasing Reporting Requirements

Providers in these programs will be subject to the terms of their APMs, and since they will have only an upside risk, they will also be subject to certain MIPS program requirements. Providers will actually see some benefits of being in this situation: they will essentially forgo some of the MIPS obligations by being part of an APM, and they could actually benefit from an improved MIPS performance score and shared cost savings from their APM. This situation bears watching, as it will be interesting to see if providers decide opt-in to the advanced APMs once they become available in January.

Providers not participating in an APM, like the OCM, or those who qualify as Advanced APM providers will be purely MIPS-eligible providers. Their situation will be quite different from what they experienced under PQRS and VBM, where there was not a lot of risk involved and practices could report on a subset of patients to meet program requirements and avoid penalties with minimal effort. For example, under the new MIPS program, quality measure reporting equates to half of the total MIPS composite score for 2017, and depending on how the provider chooses to submit data, it could require reporting on 90% of all eligible Medicare patients for a minimum of six measures. This is an exponential amount of reporting burden, along with significantly more performance risk.

With MIPS, everyone will see some adjustment to their reimbursements because of the way the program is designed. Four performance categories are utilized to determine a composite score, which will then be compared with a national threshold. For performance in 2017, the provider will see a plus or minus payment adjustment as great as 4% in 2019, depending on whether their score is above or below the threshold. The program is budget-neutral, so if CMS collects a substantial amount of money from poor performers, in theory, there should be an opportunity for high performers to earn more than 4%.

How Can Practices Prepare for a Successful First Year of MIPS?

With the recent announcement from CMS softening the original rollout plan and allowing providers to pick their pace for MIPS, it is highly unlikely that incentives will extend above 4% in the first year— virtually all participants should be able to avoid penalties with minimal reporting. However, there is a $500-million bonus pool set aside for top-tier performers, so the question remains: if this new Quality Payment Program is here to stay, why not choose to be an early adopter and reap the potential benefits of achieving high performance through the MIPS program? There is no reason to wait. We have embarked on a brave new MIPS world and there is really no turning back.

While we wait for the final rule to be released this fall, providers can take some steps to prepare for the MIPS program and position themselves for success. First, they should examine which quality measures are clinically relevant for them and decide which measures they intend to participate in beginning January 1. The measures a provider selects should be relevant and a good barometer of patient care quality or reflective of activities that impact patient outcomes.

Next, practices should engage their electronic health record (EHR) vendor to determine if the quality measures are supported through their EHR to ensure appropriate data collection. In addition to this, practices should ask their EHR vendor how it will support the practice with continuous data monitoring or reporting to track performance throughout the year, so that there are no surprises when it comes time to submit data to CMS. Does the vendor provide advanced technology solutions to help support adherence to specific quality measures—such as clinical decision support tools&mdash;or the ability to review patient lists when target measures have not been met?

Practices can no longer be successful in these programs on their own, relying on manual data entry. Innovative technology is necessary to provide actionable insight and enable informed decision-making to drive better program performance, improved patient care, and lowered costs.

Practices can further prepare by closely examining the CPIAs to see which ones they can implement now. This new component is intended to spark change so practices can adopt new and better ways of practicing medicine and engaging patients to improve care and outcomes. Ultimately, CPIAs have the potential to impact performance in other areas of the program when implemented effectively, such as providing 24/7 access to care or same-day slots to avoid more costly emergency department visits for patients in need of immediate care.

Although there are many concerns about the Quality Payment Program, CMS is taking healthcare in the right direction and there is reason to be cautiously optimistic. We need to work together as a healthcare system and remain focused on our shared vision to improve the delivery of patient care and achieve better patient outcomes.

Erin Crum, MPH, is director of Quality Reporting Programs for McKesson Specialty Health.

Nearly a decade ago, CMS started healthcare providers on the road to value-based care. Along the way, we have seen a variety of quality programs that impact community oncologists.

Erin Crum, MPH

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