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Health Plans and Provider Risk-Bearing Entities

 

HEALTH PLANS AND PROVIDER RISK-BEARING ENTITIES

Best Doctors supports health plans and providers using clinical insights from treating physicians and case managers, along with clinically intelligent algorithms, to identify and refer cases into our Expert Consult program. The Expert Consult program is enabled by carefully chosen experts from Best Doctors’ network of 50,000 physicians in over 450 specialties and subspecialties.

 

OVERVIEW DEMONSTRATING ROI RELATED ASSETS

 

What do health plans, patient-centered medical homes (PCMHs) and accountable care organizations (ACOs) all have in common?

They’re all managing risk and containing costs while improving quality of care.

Today, more than ever, effective solutions to improve the quality and efficiency of care for medically complex conditions require an understanding of how to overcome the shortcomings of our highly-fragmented health care system. This fragmentation of care often leads to misdiagnoses, medical errors and inappropriate high-cost interventions.

Best Doctors overcomes the systemic effects of a fragmented health care system with our agile, technology-enabled services and consistent, proven methodology of proactively identifying and solving the most complex, critical and costly cases to:

  • Improve quality care and outcomes
  • Contain costs in unexpected places
  • Keep patients/members in-network
  • Increase patient and physician satisfaction
  • Attain an ROI greater than 2:1

 

When you bear the risk, don’t leave it to chance. Partner with Best Doctors.

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To date, Best Doctors has conducted more than 1,500 case reviews for CareFirst BlueCross BlueShield’s robust Patient-Centered Medical Home (PCMH) program – their Total Care and Cost Improvement Program (TCCI). CareFirst is the Mid-Atlantic’s largest health insurer, with 3.2 million members and $12 billion in revenue. All reviewed cases remained in network and more than 83% of members who’s cases were reviewed followed the Best Doctors’ Expert Consult recommendations.

Best Doctors has demonstrated a valuable return on investment (ROI) for CareFirst in 3 key areas:

CLINICAL

  • 54% Change in diagnosis
  • 84% Change in recommended change in treatment
  • 48% Planned surgeries deemed to be unnecessary

 

FINANCIAL

  • Attain an ROI greater than 2:1

 

MEMBER SATISFACTION

  • 95% Rated experience to be good or excellent rating, while keeping members in network, and would recommend the program to a friend
  • Peace of mind for the individual members

 

Additionally, Best Doctors has helped CareFirst gain significant clinical improvements in four high-impact areas:

Case/Condition Diagnosis Modification Treatment Modification Average Savings Per Case
Musculoskeletal 36% of cases 69% of cases $16k
Prostate, Breast and Colorectal Cancer 11% of cases 50% of cases $12k
Heart Disease 27% of cases 61% of cases $18k
Gastrointestinal Disorders 37% of cases 69% of cases $11k

 

“By making Best Doctors an integral, collaborative part of our care review process on high-cost, high complexity cases, we are addressing and in many cases, minimizing adverse consequences while improving quality care for our members.”

—Chet Burrell, President & CEO, CareFirst BlueCross BlueShield

 

 

CareFirst BlueCross BlueShield’s an independent licensee at the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association.
® Registered trademark of CareFirst Of Maryland, Inc.

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