Podcast interview with Best Doctors President Evan Falchuk. (Transcript: Part 2)

This is the second half of the transcript of my recent podcast interview with Evan Falchuk, President and COO of Best Doctors. In Part I Evan shared his views on health care reform and information resources for patients and physicians. In this half he discusses Best Doctors, including a recent case involving his brother.David E. Williams: I want to turn now to speaking about your company, Best Doctors. Please describe what Best Doctors is and what you do.Evan Falchuk: We sell an employee benefit to companies that they give for free to their employees. We help people get the right diagnosis and the right treatment.  The way we do it is by collecting information from the patient, doing an interview, compiling records, having doctors analyze all the information and then consulting with experts from our Best Doctors database to figure out the right course of treatment.  I’ll give you an example in a second.We find overall that about 20 percent of patients have something wrong with their diagnosis and more than half have something wrong with their treatment. Those are pretty extraordinary numbers, but there has been a very interesting body of public health research that has been coming out lately that supports almost the same numbers overall. So I think what we’re seeing is the reality of what it’s like to be in the health care system.We’re a global business.  We cover people in more than 40 countries, representing more than 20 million people around the world. What we see is this problem of incorrect diagnosis and treatment happening globally in all kinds of different health care systems regardless of how people pay for care.As an easy way to understand how it works I can tell you a story that is personal to me because it’s my own brother’s case.  We helped him recently.  We did about 10,000 cases in the last 12 months. This is just one but it’s powerful for me.  He is a little bit younger than me, not quite 40.  He is the co-creator of this hit TV show Glee that maybe you’ve seen on Fox.A little while ago was diagnosed with a tumor in his spinal cord and was seen by a really leading neurosurgeon who said he’d do radiation followed by surgery on the spinal cord to take out what’s left of the tumor.He called for help and we went through our process.  In looking at his record, our doctors found out that we have a family history of a kind of malformed blood vessel in the brain and that the neurosurgeon wasn’t aware of this problem.  But it was in my brother’s records.My brother didn’t know it was pertinent but we said that it was. We asked an expert whether a tumor in the spinal cord be confused for one of these blood vessels and the expert said absolutely it could be confused, and what you need to do is do a different kind of test called an MRA in order to see.So we delivered that information back to my brother and his treating doctor and they looked at it and said whoa, we have to stop what we’re planning on doing and look to the MRA. When they did they found out that he had one of these malformed blood vessels, not a malignant tumor.  He still needed a kind of surgery to fix this but if he had had the radiation on the bad blood vessel it probably would have bled, which probably would have paralyzed him or even worse.But even if he had survived that, getting into the surgery, opening up someone’s spinal cord and suddenly you see something completely different than what you expected.  It’s a pretty bad place to be. Not every case is as dramatic as my brother’s case and actually he’s doing great.  He’s throwing out the first pitch at Fenway Park in two weeks.  That problem is symptomatic of what goes on in the system.  That’s exactly what Best Doctors addresses.Williams:            That’s quite a compelling story.  I’m glad that he’s doing well.  It sounds like you are using essentially the same template that you had a couple of years back because in fact the underlying need hasn’t changed. Health reform and other things that are going on have not made a real difference to the kinds of issues that you’re addressing.Is that correct or have you made some changes in the way you work?Falchuk:            Well we’ve been growing a lot.  In the United States we’ve been signing up large employers like Northrup Grumman and other large corporations across the country. We’re putting this in as a fundamental part of their benefits offering and really leading with it and saying: look, if you’re worried about your illnesses or whatever it is you’re facing, call Best Doctors.We are engaging more than ever now as early as possible in someone’s illness and staying with that member as long as possible after we’ve given our advice.  We are really acting as a navigator to help people figure out their way through the system and helping them coordinate their care, figure out where to go and what to do. That’s become an increasingly big part of our role.And then the other big trend that we see in our work is the globalization of benefit offerings.  Many large corporations are multinational and buy their benefits historically in local markets. But increasingly these companies are centralizing that into their U.S. operations. We’re seeing a trend towards globalization, which for us as a global company seeps into what we do.Those are the two big changes that have been happening over the last few years.Williams:            What do you see as employers first get introduced to the service, sign up and people start using it?  Is there a path where they become true believers over time or is it just that people get it because they have their own story to relate?Falchuk:            The sales process is always interesting.  When you go and you talk about what we do it’s very different from what people are used to hearing about in health care. In health care you hear a lot of theoretical ideas, whereas we’re showing up talking about real people and real situations. Everybody knows what it’s like to go to the doctor and not have enough time, and the challenges people face.So that process is really the first thing. We connect with people because we’re talking about real stuff.  When we implement with an employer we always work hard to get the employer to engage and educate the employees.  We do that work.We say: listen, it’s okay to be unsure about your care and if you are please call us and we’re going to help you and work with your doctor.  There’s always a big spike in use of our service right at the beginning because there is a pent up demand.  There are people out there daily that are facing these problems.They’re suffering alone and don’t have a resource until Best Doctors comes in. So it is always eye opening and very quickly you start generating these kinds of stories. Imagine if you’re a big company and you’ve got 100,000 employees. There may be hundreds of people in the first few weeks that call Best Doctors for help.Some significant number of them are going to have problems with their diagnosis and treatment. They call their HR department or they tell their manager: boy this benefit really made a difference in my life. It really makes what we do just tremendously satisfying when we get to hear those kinds of testimonials.Williams:            Concierge medicine seems like another approach to the same issue. Can you comment on the extent to which somebody can achieve similar results with a concierge practice?Falchuk:            It’s the notion of a practice where your doctor is going to have a much smaller number of patients.  That’s really what we’re talking about when we say concierge practices.  A doctor says I’ll see 500 patients not 5,000. The concept there is that your doctor is going to spend 45 minutes or an hour with you every time he or she sees you.  I think from what we see from our data that if a doctor could spend that amount of time with all their patients then a lot of our quality problems would be addressed.Your doctor would really be able to act as your advocate through the system.  There was a time in history when your doctor was really the guy that you stuck with that really took you through things from beginning to end. But that time has passed.  So I think those kinds of practices try to replicate it and they make sense from an individual perspective.I think it’s hard when you think about those as a policy issue. You would probably need ten times as many doctors in order to have everybody have access to the same level of care that you can get in that kind of a setting. That’s not a direction we’re heading in.From a policy perspective, being a doctor today is probably as unattractive as it has ever been because your reimbursement is lower than it has been, the pressure to see more patients is the worst that it has ever been and the pay is probably lower on average than it has been compared to other professions. So we need more doctors and we need the doctors to be able to spend more time.  That really ought to be a fundamental part of how we look at the question that you’re asking.Williams:            Those are the topics that I had laid out.  Are there other things that we haven’t covered that are on the top of your mind at the moment?Falchuk:            It’s really important that anyone when they’re sick recognizes how important it is that they be an advocate for themselves and that they ask all the questions they think they need to ask and if they’re not satisfied that they keep going.  It is the only way to make sure that you as a patient are going to get the right care.Williams:            I’ve been speaking today with Even Falchuk from Best Doctors about health care reform, patient navigation, advantages of Best Doctors and other topics.  Evan, thanks so much for your time.Falchuk:            Great talking to you.