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SFHSS board votes to let Best Doctors contract expire after low utilization and public objections
Summary
After a lengthy public comment period and presentations from health plans, the San Francisco Health Service System Board voted to allow its Best Doctors expert‑opinion contract to expire at year end; staff cited minimal uptake and lack of integration with plan care pathways.
The San Francisco Health Service System (SFHSS) Board voted on April 16, 2019 to allow its Best Doctors third‑party expert medical‑opinion contract to expire on Dec. 31, 2019, following staff recommendations citing very low utilization and concerns about integration with plan providers.
Aon consultant Mike Clark presented the recommendation, saying fewer than half of one percent of eligible members used Best Doctors since the service began in 2017. Staff proposed discontinuing the separate third‑party service for 2020 while increasing member outreach about how to request expert opinions within existing SFHSS health plans and evaluating expert‑opinion services in future vendor solicitations.
Blue Shield, Kaiser and UnitedHealthcare representatives described in‑plan mechanisms for second opinions, including referral processes and, in Kaiser’s case, access to a large Permanente physician network. Board members and plan staff discussed whether in‑plan options provide equivalent independence and whether members who are ill can easily navigate the processes to obtain a timely second opinion.
Several board members who reviewed Best Doctors' interconsultations praised the clinical quality of the case summaries and patient satisfaction but raised concerns about Best Doctors’ lack of a formal feedback loop to notify treating providers or plans when questions about diagnoses emerged. The board physician who reviewed the files recommended greater quality assurance and integration.
Dozens of public commenters—many retirees and union representatives—urged the board not to terminate Best Doctors, describing instances where the service was valuable for complex, potentially catastrophic diagnoses and urging more member outreach rather than contract termination.
Staff said it had invited Best Doctors to the hearing but the vendor chose not to attend. Directors noted that newer market offerings and alternative models surfaced during SFHSS’s recent request for information, and that integration, notification and quality assurance gaps with the current Best Doctors model made continuation difficult at historical prices.
After debate and public testimony, the board approved the staff recommendation to allow the Best Doctors agreement to expire. The board vote was recorded in the meeting minutes (four in favor, one opposed). Staff committed to posting clearer guidance on sfhss.org and working with health plans to improve member awareness of second‑opinion options.
