Even if you have insurance, trying to access health care can be a frustrating experience. Getting appointments can take weeks or months, let alone a proper diagnosis or treatment. But a company that recently expanded to Maine aims to make accessing optimal health care easy by using the power of data.
The company is called Grand Rounds, and Medical Director of Personnel Gus Crothers says it was born out of a harrowing health experience of one of its founders.
When Rusty Hofmann’s son was 8, he got very sick. Doctors struggled to figure out what was wrong. Ultimately, he needed a bone marrow transplant, and his father was a match. But at the time, a bone marrow transplant from a parent wasn’t a proven, safe treatment.
Even though Hofmann himself was a well-connected doctor at Stanford, Crothers says he didn’t know what to do.
“He was calling around to various experts around the country, he was actually put in touch with the National Institutes of Health. He called them up, said, ‘This is the situation, what should I do?’ They put him in touch with a researcher in Seattle who was studying this very question, and actually had data that hadn’t published yet,” he says.
The researcher advised Hofmann to do the transplant, and his son is now a healthy teen. But Crothers says Hofmann was troubled that even though the information was available, he had to work hard to find it.
“He realized, ‘I did all of this remotely, all of the records could be uploaded on a CD or uploaded on the internet. We could send them to the appropriate person who could give their opinion. Why don’t we create a platform like that for anyone to access no matter where they are?’‘ And that’s how Grand Rounds was born,” he says.
That was in 2012, in San Francisco. Grand Rounds now has offices in Nevada and most recently Lewiston, where Crothers works. The company contracts with local employers like Dead River and the State of Maine and national employers like Target and Walmart.
Crothers says Grand Rounds functions kind of like a personal navigator when an employee has a health care question.
“Based on our data, and our resources, based on our technology, we will know who the best person is for that question, and we will get you there, and get you that answer, and we will hold your hand every step of way,” he says.
Say an employee needs help finding a doctor. Crothers says Grand Rounds uses more than six billion data points from public and private sources to identify the top doctors in the area for the specific issue, and will make the appointment.
Or, say an employee wants a second opinion on a diagnosis or treatment. Grand Rounds pulls together the medical records and matches the case with an expert.
“What we’ve found, having done thousands of these second opinions, is that two-thirds of the time, we actually do change the diagnosis or treatment,” Crothers says.
That was the case for Melissa Spahr, a business analyst with the Dead River Co. who got a concussion in early January while skiing. She says her primary care doctor told her to take a week off work, and that full recovery could take anywhere from a few weeks to a few years.
Three months later, Spahr, a normally active person, felt exhausted and sick most of the time.
“I can’t walk a mile without feeling dizzy, like I’m going to pass out or get a migraine,” she says, “so my life had changed significantly.”
Spahr contacted Grand Rounds for a second opinion. Within a few days, an expert evaluated her records and recommended she see a neurologist. Eight days later, she had an appointment.
“Every day, while they were trying to get me into a neurologist, they checked all these different companies, and it’s not like they just stuck me in with somebody. They researched and found a really good fit. And then after the appointment, they actually called me and interviewed me about how the doctor reacted and what were the questions. Before the appointment they gave me a list of questions to ask him, so I wouldn’t forget to ask him something that I didn’t know to ask,” she says.
The doctor had Spahr do occupational and physical therapy. She was also prescribed medication and glasses. It has been about a month, and Spahr says she’s finally functional again.
Dead River VP of Human Resources Guy Langevin says the company decided to contract with Grand Rounds after one especially frustrating experience trying to help a sick employee find proper care.
“We tout our medical or health insurance as a benefit, yet when you’re going through something like this, it doesn’t feel much like a benefit,” he says.
But Grand Rounds does make health coverage feel like a benefit, he says. Companies pay a flat fee per employee every month. Langevin says it’s less than what Dead River pays for its phone bill, and he says the investment is worth it.
“The savings for us is really the efficiency of their process,” he says. “They’re going to send you to the best doctors, the right specialists for your problem.”
Not every case saves money. But Crothers says on average, Grand Rounds saves employers roughly $8,000 for every expert opinion it provides.
“And the reason that happens is health care in the U.S. is overdone. This is no secret. There is tremendous waste, there are lots of surgeries, especially elective surgeries that are performed that aren’t indicated. The incentives are not aligned between the patient, the payer, and the provider,” he says.
These are problems that Dr. Vikas Saini tries to improve as president of the Massachusetts-based Lown Institute, which seeks to reduce health care waste and overtreatment.
“What they’re doing, in terms of gathering a huge database and trying to use algorithms to mine it, to help improve care, is very, very promising,” he says.
But Saini says the problems in the U.S. health care system need broader solutions.
“Those problems, those hurdles, are less about getting the right algorithm, and a lot more about how we’ve organized the system, how we regulate the system, and obviously how we pay for things in the system,” he says.
Crothers says in an ideal world, there wouldn’t be a need for Grand Rounds. But under the current health system, he says it’s a way to reduce costs, achieve better outcomes, and make patients and employees happy.