Technology Drives Biomarker Testing Rates in Precision Oncology
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The knowledge gained from biomarker testing can help develop cancer prevention, diagnosis, and treatment strategies that specifically target a person’s cancer subtype.
Dramatic advances in molecular diagnostics and cancer research have led to a greater understanding of how cancers work at a cellular level. This knowledge is driving a new era in cancer care—precision oncology—where interventions and treatments are tailored to each patient’s disease characteristics.
Biomarker testing is an important part of precision oncology. Cancer biomarkers—the genes, proteins, or other mutations that can be tested for in cancer cells—reveal critical details about a person’s cancer.1 The knowledge gained from biomarker testing can help develop cancer prevention, diagnosis, and treatment strategies that specifically target a person’s cancer subtype. This could radically change prognoses and outcomes for many patients.2
Despite this progress, there is still a significant need to improve testing rates and physician utilization of this vital information. McKesson and The US Oncology Network (The Network), a network of more than 2500 independent, community-based providers supported by McKesson, are committed to helping solve the issues that create gaps in delivering precision oncology.
Technology Is an Important Part of the Solution
The use of biomarkers in cancer care is becoming more widespread, and today the National Comprehensive Cancer Network (NCCN) recommends patients with advanced or metastatic cancers have biomarker testing to help identify the most effective therapies.3 Consequently, McKesson has made a strong commitment to improving testing access by implementing many innovative technology solutions over the past 2 years, resulting in comprehensive testing rates nearly doubling across The Network.
Following are a few of the technological advancements that have been key to that success:
- Ontada, a McKesson business, developed a reporting platform focused on improving quality patient care called Practice Insights, which is integrated within the company’s iKnowMed electronic health record (EHR) system. Having a reporting system fully integrated with the EHR enables practices to monitor their adherence to key quality care initiatives.
- Practice Insights is designated as a Qualified Clinical Data Registry (QCDR) with the Centers for Medicare & Medicaid Services (CMS). The QCDR designation enables iKnowMed users to efficiently submit data directly to CMS without engaging a separate registry vendor, streamlining data submission and minimizing administrative burden. This allows practices to focus on key quality initiatives that matter most to patient care, such as appropriate biomarker testing and treatment, and leverage those quality performance results for value-based care programs like CMS’ Merit-Based Incentive Payment System (MIPS), the Enhancing Oncology Model, and commercial value-based care models. As a CMS-approved QCDR, McKesson can collect and report clinical data to drive improvements in quality and cost of care.
- McKesson developed several custom QCDR quality measures through the Practice Insights reporting platform, including one specifically designed to drive improved biomarker testing and targeted therapy usage.
Quicker Access to Test Results
Although it is well known molecular diagnostics are underutilized, that is only part of the problem. Study results show that when patients are tested, they may still not receive appropriate targeted treatments.4 There are various reasons for patients not receiving precision oncology therapies. For instance, the testing process can be lengthy, and obtaining results can take several weeks. Once results are available, there are often delays in uploading them into the EHR, and provider access to the information is further delayed. With anxious patients eager to start treatment, chemotherapy is sometimes initiated prior to biomarker result availability, rather than initiating treatment on the targeted therapy for their cancer. Consequently, it is critical not only to improve testing rates but to streamline access to the results. McKesson’s precision medicine team is working on a solution by integrating laboratory results directly into structured fields in the medical record, along with alerts to notify the physician when comprehensive biomarker testing is appropriate based on NCCN guidelines. We are collaborating with several national labs to import results directly into the EHR, which will then feed into clinical decision tools at the point of care when a physician is making a therapy decision. By doing this, access to biomarker test results can be shortened by 7 to 12 days, giving patients a better chance of starting on the right therapy at the right time.
Technology's Role in Health Equity
It is important to acknowledge not everyone has an equal opportunity to prevent cancer, discover it early, and receive appropriate treatment and follow-up care.5 To equalize the playing field, it is essential to understand patients’ needs and potential social drivers of health, and technology can play a critical role in achieving that goal.
McKesson has developed several strategies empowered by advanced technologies that have been adopted across The Network. For instance, the company has integrated the NCCN Distress Screening Tool into its iKnowMed EHR with a dashboard that enables the care team to review the patient’s results and act on the various needs that are identified. Eventually, McKesson will be able to stratify quality measure data by health-related social needs and barriers to care in order to better target patient outreach and connection to community-based resources, enabling improved access to care. Understanding these dynamics as they relate to appropriate biomarker testing will bolster a practice’s ability to impact access to testing, adherence to treatment, and optimized patient care.
Collaboration Is Needed
McKesson is encouraged to see the willingness of CMS to incorporate into policy quality measures related to biomarker testing and targeted therapy usage. However, we know the issues surrounding biomarker testing cannot be solved in a vacuum. Collaboration is the key.
Over the past several years, McKesson has forged a strong relationship with the American Society of Clinical Oncology (ASCO) to address quality measurement that is meaningful and impactful to patient care. For instance, we collaborated with ASCO to provide direction to CMS on which measures should be included in the Advancing Cancer Care MIPS Value Pathway (MVP). A key measure that was included in the Advancing Cancer Care MVP as a result is PIMSH13: Mutation Testing for Stage IV Lung Cancer Completed Prior to the Start of Targeted Therapy. The more we can use our collective voices to steer these regulatory programs in the right direction, the better the reporting programs become and the more useful the data will be as far as improving care.
Moving to a New Standard of Care
We hope these initiatives are only the beginning of many future collaborations among different organizations to advance cancer care, increase biomarker testing rates, and bring targeted therapies to the forefront of cancer care. While great progress has been made, more stakeholders must work together to help achieve better equity in cancer care to deliver improved outcomes for all. Normalizing testing so it becomes the standard of care, not the exception, would be a gigantic step forward in ensuring more patients can realize the benefits and the promise precision oncology offers.
Erin Crum, MPH, is senior director of quality strategy and innovation, McKesson and The US Oncology Network, and Regina Murphy, MBA, is vice president of precision medicine, The US Oncology Network.
