Health Care Execs See How Best Doctors is Solving Complex Cases

On May 24 and 25, 2017, Best Doctors held its first Executive Summit for Payers and Providers, Solving the Unsolvable: Innovations in Cost Containment for High-Impact Cases. This Summit, hosted by CareFirst BlueCross BlueShield, gathered thought leaders in the health care industry to find solutions to one of health care’s most challenging issues: critical, complex and high-cost cases. Download the slides from one of our sessions, “Decreasing Cost and Improving Quality of Care in Highly Complex Cases.”

The first night offered a chance for networking at the Sagamore Pendry, a newly opened boutique hotel in Fells Point, Baltimore. The attendees, executives of many prominent health care organizations, had a relaxing evening mingling with the Best Doctors team and fellow attendees.

The second day was kicked off at the CareFirst BlueCross BlueShield Headquarters by Chet Burrell, CEO and President of CareFirst, whose welcome address explained why Best Doctors was important to CareFirst, and the conversation that followed featured engaging discussions on what optimal clinical quality was and the challenges in achieving it. Among the payer and provider organizations, we found many of the challenges in managing risk and quality care were due to the shortcomings in our health care delivery system.

The Best Doctors solution is uniquely designed to mitigate these shortcomings with our comprehensive solution:

  • Focusing on the right diagnosis and treatment: Diagnostic accuracy is of the utmost importance—to both professionals and patients. Each time a patient receives a misdiagnosis or delay in diagnosis, it takes a mental and financial toll. However, as Mark L. Graber, MD, founder of the Society to Improve Diagnosis in Medicine said, “Diagnosis is hard. There are 10,000 diseases and only 200 to 300 symptoms.” Second opinions are a top solution to medical error, and Best Doctors prioritizes finding the right diagnosis and right treatment with peer-identified, nationally recognized experts who provide a non-biased review of the patient’s entire medical case. This yields significant improvement in the quality of medical care and member experience.
  • Facilitating physician collaboration: “Best Doctors’ offering is brilliant. It works in concert with physicians and not in opposition to them. That is key,” said Juan Davila, Former VP Health Care Quality Affordability, BlueShield CA. Top experts review each case, and Best Doctors clinicians work with treating physicians to ensure the patient gets the best care, so the patient doesn’t have to go out of network. At CareFirst, 80 percent of treating physicians characterized the Expert Consult Report findings as “useful in the management of the member.”
  • Lowering excessive costs: Patients get millions of dollars’ worth of care they don’t need—sometimes at a detriment to their health. In finding the correct diagnosis and treatment, Best Doctors can contain unnecessary costs. Over our 4-year partnership with CareFirst, we’ve reviewed 1,500 cases and saved an average of $10,000 for each case, though some saw much higher savings.
  • Identifying high-cost cases: Technological innovations, like predictive health analytics, are helping payers and providers, such as ACOs, PCMHs and more, get a whole picture of a patient. Best Doctors uses powerful analytics to analyze claims and pharmacy data to identify patients who may be struggling with costly or complex conditions and proactively bring this to the attention of care managers or physicians.

“When identifying and managing high-cost, highly complex patients, you have to work with multiple partners and bring both data and the experience of the providers that are taking care of the patients together to make true determinations,” said John Bulger, DO, MBA, Chief Medical Officer of Geisinger Health Plan. “Best Doctors will help us to educate our providers at understanding cues and will help us run algorithms on our data to identify the patients who will most benefit from an expert second opinion.”

Download the slides from one of our sessions, “Decreasing Cost and Improving Quality of Care in Highly Complex Cases” to learn how Best Doctors’ helps CareFirst put members at the center of their care, solving many of the issues both payers and providers face in health care delivery.

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