Second medical opinions – helping individuals and businesses alike
The number of providers offering second medical opinion services in the UK is on the rise. Emily Perryman (from Health Insurance Daily, UK) spoke to Dominic Howard (pictured), director Europe at Best Doctors, about how the company aims to stay ahead of the competition.
Getting a second medical opinion in the UK has – until now – not been the norm, but a change in people’s mindsets and the advent of online self-diagnosis means it is a rapidly growing phenomenon.
In the past couple of years several new companies have launched propositions, and the NHS even has a dedicated section on its website explaining how to get a second opinion.
But the brand most associated with second medical opinions continues to be Best Doctors. Dominic Howard, the company’s director for Europe, says it has managed to fight off competition because it has been around for longer than anyone else, it has the largest database of doctors and it has a strong focus on quality – as evidenced by several certifications, including ISO 9001.
There are more than 50,000 doctors on the company’s global database and, Howard stresses, all of them are peer-reviewed.
Before adding a physician, Best Doctors will approach the head of a teaching hospital to ask, “If you were diagnosed with this condition who would you want to treat you?” It will then go to each doctor on the shortlist and ask them the same question, resulting in a pool of renowned experts in their field.
“We could choose doctors on the basis of outcome scores, and that’s fine for routine procedures like hip operations, but there’s a risk that if a doctor wants to keep a high score they will turn away cases that are complicated. That isn’t the type of doctor we want on our database,” Howard explains.
The process users go through is also rigorous. The initial call with a nurse is around an hour long and the user will remain with that nurse until the end of the process, when they explain the doctor’s medical opinion.
Rivals to Best Doctors have criticised the fact that patients don’t get to see a UK doctor face-to-face. The specialist could be based in a country on the other side of the world.
But Howard argues that the ability to store and transmit information today is so good that face-to-face communication is no longer necessary. He points out that many doctors in the UK do things remotely.
“We can create such an accurate picture that it is like putting the patient in an envelope and sending them to the doctor. And it doesn’t mean the patient can’t continue their face-to-face relationship with their GP. Our mission is not to replace treating doctors, but to support them,” he adds.
Insurers seem to agree with these claims, as many have adopted the Best Doctors service and have been offering it for several years. Clients include Aviva and AIG Life on the individual protection side and Canada Life and Generali on the group protection side. Best Doctors is also provided by some cash plan providers like Westfield Health.
The company offers insurers lots of assistance, such as helping marketing teams to communicate the benefits of the service, collecting medical records and providing data about changes in treatment.
“All of the insurers have told us about the benefits the service brings for sales and retention,” Howard says.
Although Best Doctors is highly regarded, it isn’t resting on its laurels. The past year has been extremely busy, with several deals and partnerships signed.
A year ago it entered into an exclusive partnership with IBM in the US. The technology giant has an artificial intelligence service called Watson which helps physicians diagnose and treat patients by mining patient data, combining this with test findings and then forming hypotheses.
For cancer patients, the Best Doctors team collects medical records and feeds relevant data into Watson, which then generates a report to be reviewed by expert oncologists in the Best Doctors network.
“Doctors need to read about 150 hours’ worth of material to keep up-to-date with medical developments. Watson enables them to get access to the world’s medical library, but just the parts that are relevant for their patient,” explains Howard.
Best Doctors is planning to launch this oncology service with a UK insurer in the fourth quarter.
The company also owns a data analytics company, called RISE. It acquired the business in 2014 and this year completed its integration into the group. Howard claims it enables Best Doctors to leverage the information gathered from the thousands of cases it has seen over the past 28 years. For example, ascertaining whether certain conditions are being misdiagnosed or whether particular doctors are overprescribing.
“This helps us move into the area of cost containment, which includes direct medical costs, such as drugs and physio, and the indirect costs of someone taking time off work,” states Howard.
Private medical insurance
Best Doctors hasn’t – as yet – been embraced by UK private medical insurers. Howard thinks they are missing a trick.
“Best Doctors presents a massive opportunity for private medical insurers to not only differentiate themselves, but also to know whether they have patients who are costing them more money than they should be,” he says. “A lot of healthcare costs are unnecessary and a large bulk of that is due to misdiagnosis.”
Howard points to figures from the Mayo Clinic suggesting more than 20% of patients who sought a second medical opinion for serious conditions had been misdiagnosed by their primary care providers.
Of the cases handled by the Best Doctors EMEAA team, 17% result in a modified diagnosis and 35% of members are recommended an alternative course of treatment.
Private medical insurers are perhaps concerned that a second medical opinion will increase costs.
“In fact it is the exact opposite,” Howard argues. “We’re not telling patients where to go for treatment – for example a hospital outside the insurer’s network – we’re just giving a recommendation which they can share with their consultant. We keep things impartial.”
An area Best Doctors is looking to expand into is mental health. The company has traditionally focused on physical conditions, but it recently completed a mental health pilot in Canada.
The pilot involved creating a panel of mental health specialists who did a phone-based assessment of whether the patient had been given the right diagnosis and treatment, and to what extent they might need services like cognitive behavioural therapy. It is now a fully launched service called Onward.
“We will do a pilot in Europe and we are exploring how quickly we can bring this to market in the UK. The overall principle is to provide second opinions for mental health,” says Howard.
In July, Best Doctors was acquired by US telehealth company Teladoc. Howard says Teladoc is focused on high frequency, low severity patients whereas Best Doctors is about low frequency, high severity conditions.
“The combined company will offer the full continuum of care: from minor conditions all the way through to end-stage cancer,” he adds.
Best Doctors intends to make its service directly available to employers next year, but Howard says this will be in a way that doesn’t conflict with group risk. One possibility is for employers to offer the service to workers when it cannot afford private medical insurance.
Howard believes the biggest challenge for the market is the fact that there is no centralised database of patients’ medical records in the UK.
“Getting information is hard – and it’s something insurers also struggle with. Until we see medical records on one system this will be a challenge,” he states.
Overall he is positive about the future of second medical opinion services. He say the market has been fuelled by the internet and so-called “cyberchondriacs”, who are costing the health service millions of pounds a year in needless appointments.
“The internet has resulted in more people questioning what their doctor tells them,” he says. “It’s partly generational. Best Doctors is about making sure no stone is left unturned.”
Dominic Howard biography
Director, Europe, Best Doctors
Dominic has nearly thirty years’ experience within the accident and health insurance and reinsurance sector – working for companies on both the broking and underwriting sides of the industry.
In 2006, he was hired by Best Doctors to help build the business across Europe. In his role he has spearheaded the growth of the Best Doctors brand through relationships with both insurers and the intermediary market.
Prior to joining Best Doctors, Dominic held senior business development roles with Aon Managed Care and Jardine Lloyd Thompson. His career has seen him travel extensively, and has included secondments in Hong Kong and the Middle East.
Dominic holds a Master’s Degree in Medieval History and Fine Art from the University of St. Andrews.
He is a keen sports enthusiast as well as having an interest in wine, film and theatre.