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Board debates Best Doctors second‑opinion program after utilization report
Summary
Best Doctors reported 744 contacts and 509 opened cases (413 closed), with 44% of closed cases showing a diagnostic adjustment and treatment‑plan changes in many instances; commissioners pressed for clearer methodology, interim cost‑savings figures and better promotional targeting.
Nancy Oh, account executive for Best Doctors, presented closed‑case utilization covering three full quarters: 744 member contacts, 509 opened cases and 413 closed cases. Of the closed cases, Best Doctors reported that 44% had an adjustment in diagnosis and 87 cases exhibited a change in treatment plan; the vendor said those figures include a range of outcomes from minor clarifications to substantial changes.
Board members pressed for more granular reporting. Commissioner Follinsby and others asked for a clearer distinction between "refinement" of a diagnosis (a nuance or added detail) and a true diagnostic change, and requested the methodology Best Doctors uses to estimate cost impacts. Commissioner Follinsby said the wording on the slides risked appearing promotional and asked the vendor to provide clinical impact summaries that document how cases were classified and how projected savings were calculated.
Best Doctors said the vendor compiles a supplemental, de‑identified clinical impact summary that contains projected savings per case and that an aggregate savings report would be included in the annual report; the board asked for an interim aggregate savings summary covering the three quarters already analyzed. HSS staff committed to obtain an interim cost‑savings breakdown and to refine labeling on slide materials to avoid overstating clinical impact.
Several board members and public commenters noted member value for peace of mind. Two members who used the service described hour‑long consultations with out‑of‑network specialists (one with a Cleveland Clinic cardiologist) and said the experience produced valuable guidance. Other commissioners raised concerns that aggressive promotion can generate misdirected calls (billing or enrollment issues) and that call volumes should be disaggregated to quantify which contacts were appropriate second‑opinion requests versus administrative inquiries.
Next steps: HSS will ask Best Doctors for interim aggregate savings estimates and methodologic documentation; staff will refine public slide language and include the savings summary in materials for the board’s contract review cycle.
