Comprehensive Guidance for Your Most Complex Members

Provide expert medical opinions, effectively reducing healthcare waste and improving health outcomes.

Put an end to high healthcare costs. Improve Health Outcomes.

For most employers, 20% of their population drives 80% of healthcare costs due to chronic and complex conditions. Unfortunately, a sizable number of those cases are misdiagnoses or are improperly treated because most doctors aren’t experts in every condition, nor are they of the same quality across the board. If improperly diagnosed, they’ll still follow the prescribed treatment—sometimes for months or years—with no chance of ever getting better. In some cases, conditions actually worsen and doctors resort to increased usage of prescription drugs.

The Need for Better Diagnoses.

Most doctors aren’t experts in every condition, nor are they of the same quality across the board. Many of your members, without access to clinical expertise and support, will likely accept the first diagnosis they receive after seeing the first available in-network doctor they can find. And if improperly diagnosed, they’ll still follow the prescribed treatment—sometimes for months or years—with no chance of ever getting better. In some cases, conditions actually worsen and doctors resort to increased usage of prescription drugs.

The Costs of Unnecessary Medical Care.

On average, it’s estimated that 20-30% of overall medical care is not needed, including:

25%

of tests

22%

of prescriptions

11%

of procedures

For companies with self-funded healthcare plans, this directly affects their bottom line. The costs spill over into lost employee productivity and increased internal administration.

Benefits of Offering an Expert Medical Opinion.

Reduce Wasteful Spending

on unnecessary surgeries and prescriptions, low value care, hospitalizations, and more. By improving care plans, Grand Rounds has been able to deliver a 2:1 ROI, including $9,000 savings per EMO and $2,200 savings per Concierge Referral.

Improve Health Outcomes

for members so that they are healthier and happier, leading to increased productivity. According to Grand Rounds, EMOs ensure members get the right care, resulting in a 67% change in treatment and 11% change in diagnosis. 37% of EMOs following a surgery recommendation lead to cancellation of the procedure.

Deeply Satisfy Members

by ensuring that complex members have a smooth ride through the healthcare system. When your members appreciate their benefits, they’re more likely to stay.

Real People. Real Impact.

Beth's Story

“Customer service is outstanding. I felt like I mattered.” Beth said, “They matched me with a provider that diagnosed me 100%. She suggested medication, continuing the course that I was on, as well as weight loss.”

More than Just a Second Opinion.

Today, there are several providers of second opinions. Grand Rounds takes it one step further by giving members access to experts in their condition, high quality local care to carry out treatment, and an empathetic care and clinical team to guide and support.

Quality Measurement.

Our solution identifies the deep expertise necessary to properly review complex patient cases, and we have curated a panel based on an objective measure of clinical quality. Using machine learning (ML), we can incorporate much more data, and develop models much faster—measuring quality across specialties with unmatched precision and scale. The result is much richer models, in any given specialty such as primary care, than currently exists in the universe of metrics.

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Clinical Expertise (Local and Remote).

Our selective expert panel of 4,500 world-class physicians was selected using our proprietary quality measurement models to identify top-tier expertise across every medical specialty. We also use a physician-led care model to offer wrap-around guidance to complex members, with close to 100 on-staff clinicians (MDs, NPs and PAs). And, our connection to top local doctors ensures that members have support to carry out their recommended treatments.

Complete Care Experience.

Our approach takes into account the emotional and financial burden that accompanies a complex clinical situation. We have an award-winning care team of 200+ care specialists who can address any member need, including clinical, financial, and emotional aspects of care. There are no call quotas, call scripts, time limits, or strict protocols as we triage situations and work to remove barriers to care. Every interaction is a personalized, real-time experience. A harmonized member experience removes barriers to care and supports members in the clinical, financial, and emotional aspects of addressing a complex clinical situation.

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Continuous Innovation.

We are committed to finding new ways to augment the healthcare experience to drive out waste and improve clinical outcomes every year. We’ve redefined age-old deficiencies in the healthcare experience. For example, we started with just EMOs and then saw that members would benefit from high- quality local physicians who could actually carry out care. Then, we added financial support (claims advocacy and claims history) because complex members have complex financial needs. We built out claims-based targeted outreach capabilities to proactively identify and engage members most in need of our services. Most recently, we created the Triage function, to connect members with a care team member upfront who can get them to the right place. This improved convenience, empathy, and efficiency.

Connect with Grand Rounds to learn more about what you can do to improve the quality of healthcare for your members.

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