Misdiagnosis - Should Corporate America Get More Involved?

David Seligman

Mar 10, 2020

Right now, if you are sitting in a physician's waiting room with three other people, statistics show that one of you is likely to receive an incorrect or incomplete diagnosis. Misdiagnosis has become a public health crisis. This may seem alarmist given that we live in an age of such great medical advances, but it's true. The repercussions affect employers of all sizes in every industry. So should companies get more involved?

Despite the “latest and greatest” medical technology and procedures, at least 15 - 28% of patients still receive the wrong diagnosis, according to published studies. Those incorrect diagnoses often lead to incorrect or ineffective treatment plans, leaving many in a medical limbo where they are undergoing expensive treatments but seeing little in the form of positive results. A University of Michigan Comprehensive Cancer study found that after a review of pathology, 29% of breast cancer cases resulted in a change in interpretation, while in 34% of cases a change in surgical management was recommended.

This problem costs lives, and causes needless suffering. Added to this, nearly one-third of the roughly $3 trillion spent each year on health care in the U.S. are considered to be wasted dollars – many of which are tied to misdiagnosis and medical error.

The human toll of misdiagnosis is tremendous. It deprives patients of needed care and exposes them to the side effects of inappropriate treatment. It generates untold expenses from incorrect treatment, surgeries and prescriptions, and can often mean deadly consequences when a condition goes undiagnosed and gets worse.

Well-meaning, but time-strapped doctors find themselves in an overburdened, fragmented health care system. The bottom line is it's hard to deliver high-quality care in a system in which doctors don't have enough time with – and information about – their patients.

Now many Fortune 500 and 1,000 companies, affected by lower productivity and higher healthcare costs, are getting involved by proactively asking the question: What can employers do to help reverse this phenomenon? Many of the most forward-thinking employers now offer expert second opinion services to employees as a benefit. That step alone has helped take thousands of employees and members from the realm of medical uncertainty to a clear diagnosis and treatment path. In the tens of thousands of cases that Best Doctors, Inc. reviewed last year alone, diagnoses were corrected or refined in 37% of them with treatment plans being corrected or improved in 75%. 

Many of the country's leading employers are now beginning to understand the positive impact that analytics can play on the care and benefits landscape. Employees want personalized healthcare benefits that cater to themselves, their families and their unique health concerns delivered in conjunction with local providers. Analytics offer the opportunity to identify savings opportunities that don't require cutting back on benefits.

This is great news for both employees and employers alike. Implementation of a successful analytics program provides transparency in regard to the health of an employee population, allows employers to identify disease trends, and drives focus in regard to implementation of health, wellness or care management initiatives. Prospectively, analytics supports more accurate budgeting and forecasting, eliminating surprises.

Health plans have been incorporating analytics successfully for years. As self-insured organizations, many employers are looking for the same insight as healthcare costs continue to rise at an accelerating rate. Data analysis should support a continuous flow of real-time actionable information base on rapid data integration capabilities and a robust and customized reporting platform. Access to a robust reporting platform supports quality assurance, benchmarking, adhoc analysis and customizable reporting capabilities.

Predictive analytics can be defined as machine learning technology that can analyze and learn from data to predict and improve the outcome or behavior of a patient. Predictive analytics combines employer level data sources with other market data delivering important insights, such as identifying the outbreaks of flu, or creating personalized health care experience, such as using historic and personal data to help people deal with depression and chronic deceases. Predictive analytics can also create recommendations or predictions of patient outcomes. For example, Amazon's recommendation algorithm that analyzes millions of records and your shopping habits to suggest relevant content that can empower and facilitate decision-making. Big data already helps retailers understand shoppers better by utilizing mobile and social data that's available to them. In the same manner, employers can benefit greatly from a predictive data-modeling engine.

In our experiences at Best Doctors and Rise Health, there are four key steps to successfully applying analytics to an employee benefits program:

1.Design a proactive AND reactive approach

Along with historic analysis, consider utilizing analytics to get ahead of healthcare trends that drive higher costs

2. Organize your analytics around the employee

Analytics by themselves don't create action. Organizing analytics around the needs of employees and aligning services appropriately is critical.

        3. Evolve to a community model

Benefits that feel customized to the employee and create better-informed patients and that connect to the local primary care community create a community health model that can lowers costs, improves quality and enhances satisfaction.

        4. Provide multiple access points

Annual benefit enrollment can't be the only time that employees receive communication regarding benefits. Access should be driven by need in order for benefits to be utilized to their maximum capacity.

Medical uncertainty is a major problem that affects employees and every company's bottom-line. Predictive analytics, together with clear communication with employees about taking charge of their own health and wellness, will make a great difference. Most importantly, they will create a healthier, happier, more productive workforce – while making a positive financial impact in the process.

About the Author

David Seligman is Chairman and CEO of Best Doctors, Inc., a global health company that brings together the best medical minds in the world to help members get the right diagnosis and right treatment.