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. 

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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.

Lydia Mills, MSW, LCSW, LICSW

Articles

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