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Board questions Best Doctors' $1.4M claimed savings; renewal deferred pending data
Summary
Best Doctors presented 2017 results (142 expert second opinions, ROI 1.35:1, about $1.4M in reported cost avoidance). Commissioners pressed on the cost-savings methodology and case-level assumptions; the board deferred a motion to renew the contract at $1.40/employee-month until staff provides detailed case-level reconciliations and membership counts.
Representatives from Best Doctors presented their 2017 program results to the Health Service Board and described clinical and fiscal outcomes from the expert second-opinion service.
Heather Underhill (Director of Client Management) said Best Doctors closed 391 Find-Best-Doctor cases and 142 interconsultations (expert second opinions) in 2017; the company reported a program ROI of about 1.35:1 and estimated approximately $1.4 million in cost avoidance using Best Doctors— costing methodology. Dr. Harrison, Best Doctors' medical director, described clinical impact measures: roughly 75% of second-opinion cases produced some diagnostic impact and about 10% produced major diagnostic changes; musculoskeletal conditions and secondary neoplasms were frequent cost-avoidance drivers.
Commissioners probed the cost-savings assumptions. They noted Best Doctors— methodology relies on charge-based databases (e.g., HCUP) and questioned whether charge-based estimates translate to the negotiated, paid amounts actually borne by the plan. Commissioner Follinsbee reviewed case summaries and raised specific examples where the presented avoidance figures appeared inflated or where routine $800 consultation-cost avoidance was included automatically. Commissioner Sass and others warned that charge-based measures often overstate savings relative to negotiated allowed amounts.
Aon recommended a conditional renewal at a guaranteed minimum fee of $1.40 per employee/retiree per month while negotiating alternative payment approaches. The motion to continue Best Doctors at $1.40 per member per month was moved and seconded but the board ultimately deferred the renewal decision until staff and the actuary provide full supporting data (detailed membership counts, case-level cost reconciliations, and an impact audit) that will be considered as part of the rates-and-benefits cycle.
Public commenters and some commissioners urged care in protecting early retirees and urged follow-up on cases where unnecessary procedures appeared to have been avoided.
