By Evan Falchuk

This afternoon, I’ve been asked to testify at the legislature of the state of Michigan about their health care reform effort.  My testimony is to the Michigan House’s Public Employee Health Care Reform Committee.

On the panel with me are:

• Mike Duggan, CEO, Detroit Medical Center
• Mike Shibler, Superintendent of Rockford Public Schools
• Lori Spotts, Tecumseh Education Association President, on behalf of the Michigan Education Association

Testimony is scheduled to begin sometime after 1:30 today.  After it’s done, I’ll post my prepared remarks.

UPDATE: Mike Duggan didn’t speak, but a senior executive from an educational association took his place.  It was a fascinating hearing, and I will post some observations later.  Meanwhile, below the “Read More” you can read the prepared remarks I delivered to the committee.

TESTIMONY BEFORE

HOUSE COMMITTEE ON PUBLIC EMPLOYEE HEALTH CARE REFORM

October 29, 2009

By: Evan Falchuk
President
Best Doctors, Inc.

Madam Chair and Committee members.

Thank you very much for the opportunity to talk with you this afternoon.

My name is Evan Falchuk.  I am the President and COO of Best Doctors, Inc.  Best Doctors is a company that, since 1989, has provided a service which many people call “clinical advocacy.”  Clinical advocacy is part of the legislation you are considering.  Best Doctors sells its clinical advocacy as a benefit to employers across America, and in two dozen other countries, covering more than 10 million people.  Every year, we help thousands of people take control of their care and get the right diagnosis and treatment.

I’m here today to talk to you a little bit about why clinical advocacy is important.  There are two reasons.  First, every day there are thousands of people struggling, often on their own, with medical uncertainty—unsure whether they have right diagnosis or treatment.  And second, because by helping these people get control of their healthcare you, as the people paying for this care, can save a lot of money.

I can illustrate its value most clearly by telling you what my company, Best Doctors does.  Our role as a clinical advocate is based on the core principle that every person is entitled to be sure they have the right diagnosis, and the right treatment.

The reason this is important is that huge numbers of people get the wrong diagnosis and treatment.  According to scientific studies, as many as one in five people get the wrong diagnosis, and as many as half get the wrong treatment.  Just this week, Thomson Reuters reported that this “quality gap” is one of the biggest drivers of the $800 billion wasted in this country every year on health care. Clinical advocacy fixes this problem by helping people be sure they have the right care.  This way we can make sure that health care dollars are not wasted and that people don’t suffer needlessly.

So how does it work?  Best Doctors sells its service to employers, who give it, for free, to their employees as a benefit.  While employers pay us for this service, the people to whom we dedicate our work are the employees and their doctors, and our focus is making sure that employees and their doctors are able to work together to serve the best interests of the patient. A major part of our work is to educate employees to be smart, engaged healthcare consumers—to ask questions and to make sure they are satisfied with the answers.

Here is an example of how our clinical advocacy service works.  We helped a woman – I’m going to call her Ruth, but that’s not her real name.  Ruth works for a large manufacturing company that has Best Doctors as a benefit.  She was suffering from symptoms that her doctors decided had something to do with her thyroid.  She was referred to a specialist, who ordered a biopsy of her thyroid to see if there was something wrong with it that would be causing her problems.  The results came back “inconclusive,” no one was sure what was really wrong.  So Ruth’s doctors told her to go home with some medications and come back in six months or a year for a follow-up.

At first, Ruth accepted this, but after a few weeks of treatment, she wasn’t feeling any better.  She felt uncomfortable with the idea of waiting as long a year to see what was wrong.  So since she had Best Doctors as a benefit from her job, she called and asked us for help.  The specifics of Ruth’s experience were much like that of any of the thousands of other people we help.

When you call you are connected with one of our nurses, who takes a detailed history of your condition.  We ask you to sign a release that authorizes us to collect your medical records.  We then deploy a team of people that collects your medical records.  We then assign two internists to review all of this data to figure out what the important issues are.  Then we select a specialist from our database of nationally-recognized experts who is especially suited to answer the very questions posed in your case.  And then, finally, we deliver our response back to you and your doctor, and work with you to help you make the right decisions for yourself.

This process is what Ruth followed, and here’s what happened.  As part of our process, we retested her tissue samples and presented the case to an expert who is a renowned leader in the field of thyroid conditions.  In his view, the test result was a sign that there was something very wrong, most likely thyroid cancer.  In his view, the right course of action was not “wait and see”, but to do surgery to remove the thyroid.  As in most of our cases, when we present this kind of finding we show not only the opinion of the doctor, but the academic literature that supports the conclusions given.

We delivered this information back to Ruth and her doctor.  After they reviewed it, they agreed that the right course of action was to go ahead with surgery, which she had a short time later.  Her doctors, now in possession of her entire thyroid, conducted a thorough exam of it.  They found that it was riddled with cancer.  Had Ruth waited a year or even six months to figure this out, she faced the likelihood that this cancer would have spread to other parts of her body.  She would have needed surgery to take out her thyroid, but would also have needed a difficult, prolonged treatment to try to save her life.

The work we do at Best Doctors, and the work of clinical advocacy, is all about helping patients and their doctors get these important decisions right.

And as you can see from a case like this one, the impact is financial, too.  In the short run, Ruth’s case probably cost more than waiting would have cost.  But in the very few months that followed, she avoided a great deal of suffering, and, importantly avoided major treatments that would have cost a great deal of money and profoundly affected her life.

Clinical advocacy is, in short, the surest way to have a real and immediate impact on the cost of health care.  And what’s more, you get this real and immediate impact on cost by helping people get higher quality care.  According to our data, on average, every time you help someone get the right care, you save as much as $20,000, and that’s just in the immediate, acute cost of care.  I’m not counting the long-term impact on medical costs, productivity and the quality of life.  I mean to say that the right care is, in fact, the cheapest care.

If it sounds too good to be true, it shouldn’t.  There is old wisdom that has guided our way as Americans for hundreds of years that seems to have been forgotten in health care.  Take Ruth’s case.  It reminds me of one of the most famous of these- “a stitch in time saves nine.”  All it means is, fix the problem now, or face a more difficult one later.  Or how about another one, “measure twice, cut once.”  The idea that this kind of a second medical opinion leads to lower costs and better outcomes really ought to be second nature.

But whatever expression you want to use, the point should be clear.  In all the complexity and actuarial analyses and everything else we’ve piled on top of health care in the last 30 years, we’ve lost sight of far too much of this basic American common sense.

Let me tell you what this means in real life.  Every year, as many as 1 in every 100 people faces an important medical decision. According to data we’ve collected at Best Doctors, as many as one out of every five of these people is going to be, like Ruth, starting out with an incorrect diagnosis.  Sometimes this is very serious, like in her case, sometimes less so.  But in any event, these wrong diagnoses lead to a lot of unnecessary medical expense, and human suffering.

The same is true about treatments.  As many as half of all patients have an incorrect treatment plan.  There are many reasons for this, and often this is because of having a wrong diagnosis.  But the result is the same – unnecessary suffering, and wasted medical dollars.

But you don’t have to believe me.

There is a great deal of data from scientists, public health researchers, and the federal government that show what’s going on in our health care system.  Data from the federal government show that more than half of doctor visits involve time with the doctor of less than fifteen minutes.  Most people know what it’s like to feel rushed in these kinds of meetings, and doctors are the first ones to complain about what can happen when you force them to make complicated decisions quickly and on the basis of limited or fragmented information.

For example, most people are familiar with the seminal study from more than a decade ago in which the federal government found that more than half of people didn’t get the recommended treatment plans.  More recent studies suggest that the situation may not have improved in the last ten years. Other studies around the question of misdiagnosis, published in the Archives of Internal Medicine, and in the Journal of the American College of Medicine, show that 15% or more of patients get the wrong diagnosis.

These studies consistently show that when you force doctors and patients to rush through the health care system that costly, avoidable misjudgments happen.  I’m not talking about malpractice, I’m talking about costly misjudgments that can and should be avoided.

Now, it’s not all bad news.  Programs of clinical advocacy make it possible to address this problem without changing the entire health care system. It helps patients become better informed consumers of healthcare, and it means you can have a real and immediate impact on the quality – and cost – of health care.  And many, many employers across the country are doing it already.

It’s across numerous industries.  Best Doctors today serves customers in high technology, like EMC, pharmaceuticals, like Wyeth, manufacturing, like Delphi and Northrop Grumman, trucking like Schneider National, financial services companies like GMAC, labor unions like International Union of Operating Engineers – Local 4, teachers groups like Southern California VEBA and the Allegheny County Schools Healthcare Consortium, and many, many others.  These groups and others, and the millions of people who work there, are finding that by helping their members get the right diagnosis and treatment, they can have a real and immediate impact on the cost of care.  And a real and immediate impact on the quality of the lives of the people they serve.

Thank you.