Grand Rounds Raises $40 Million to Help Patients Access Specialists

6/24/14Follow @xconomy

For about six months, Pat Martell experienced persistent headaches. He went back and forth with his doctor about treatments, but the aspirin and amoxicillin they tried weren’t working. “The doctor was out of ideas,” he says.

After an MRI, he got a call telling him to go straight to the emergency room: His doctors had found a brain tumor with multiple cysts.

At 22, Martell was hit with a bombshell diagnosis that needed immediate action. “We’d never had the experience of knowing anyone who has had brain surgery done,” he says. “We didn’t know where to go. And we did want a second opinion on course of action.”

Martell’s parents called a doctor friend for advice, and he suggested they get in touch with Grand Rounds, a San Francisco-based startup that connects patients to qualified specialists, both to set up treatment in their area, and to get a second opinion from doctors around the country. “We actually do, despite everything you read, have great healthcare in this country,” says Grand Rounds CEO and cofounder Owen Tripp. “The problem of all of it is an unfair lack of access. What Grand Rounds does is provide access to state-of-the-art care for the sole purpose of improving outcomes for patients.”

Tripp and his co-founder, Lawrence “Rusty” Hofmann, a professor of radiology at Stanford, founded the company three years ago, and so far they have 35 corporate customers, which cover approximately one million employees. Today, the company announced a Series B round of $40 million led by Greylock Partners, with participation from Venrock and Harrison Metal, bringing total funding to $51 million. The startup has less than 50 employees and approximately 1,000 consulting physicians, though it does not disclose the number of physicians it has on staff.

Tripp and Hofmann launched Grand Rounds with two goals: One, to connect patients to the best possible doctors, and two, to reduce the amount of money companies spend on healthcare. “What we really are after is making sure that no matter where you are as a patient in your healthcare journey, we get you connected with the best of the best,” Trip says. “The clever part about all of this is we actually save the patient, we save the system, a whole bunch of money. The biggest driver of costs in system today is inappropriate or ineffective care—things doctors or hospitals are trying that don’t deliver resolution.”

Eliminating incorrect diagnoses and unnecessary care by getting patients to the best doctors at the outset is a huge value proposition for the people who pay for the bulk of healthcare costs—namely employers, Tripp says. Though individuals can pay for Grand Rounds’ services out of pocket if necessary, the majority of the company’s customers are employers. They pay a monthly fee per employee, depending on the size of the company. Those with fewer than 1,000 employees, for example, pay $10 a head. Companies with between 2,500 and 4,999 employees pay $6.

There are, of course, other companies that offer easier access to medical treatment. New York-based ZocDoc, for instance, helps patients find doctors, including specialists, and book appointments online. Sherpaa, also based in New York, connects patients and doctors via video, apps, and text. In Boston, Best Doctors offers up second opinions, and institutions like the Cleveland Clinic have similar services.

Grand Rounds offers three main products. Visits connects patients with specialists in their area. With Opinions, the company gathers all of the necessary data—medical records, lab results, x-rays, etc.—and assigns the case to a staff doctor. That physician then connects with one of the top specialists in the field to review the case and reconsider the diagnosis. The third product, Stat, is for emergencies. If a patient is already in the hospital, he or his family members can connect with a specialist at the top of the field to work with the treating physician to figure out the best treatment options.

Patients who purchase Grand Rounds’ services directly pay $7,500 for Opinions and Stat products, while Visits costs $200.

Martell, the brain tumor patient, came in as an individual customer. Grand Rounds connected him with neurosurgeon William T. Curry at Massachusetts General Hospital. Martell went to the ER on a Thursday; Friday afternoon he was in Curry’s office, confirming his diagnosis and talking about surgery options. A month later, he was back at work, cancer free.

Martell believes that without the help of Grand Rounds, he could not have been connected with such an accomplished surgeon so quickly. “ It’s not something you really want to wait around on,” he says.

Though the service aims to help patients, when Tripp and Hofmann first started thinking about it they focused on doctors’ needs. Hoffman is an expert in blood clots—specifically those that develop in veins in the leg. He was frequently asked to review cases from patients around the world, but without having all of the necessary information—medical history, test results, etc.—he couldn’t do it. “He’s got a gift a lot of people in every state could benefit from,” Tripp says. “How could we create a marketplace that would allow the Dr. Hofmanns of the world to treat patients safely without having them to fly for treatment at Stanford?”

Grand Rounds addresses of the problem by collecting all of the information doctors need to treat a patient. Staff members make the calls and collect the records, then Grand Rounds uses software it has created to digitize all the records and allow doctors to review patient cases.

Recently, Sumit Shah, a staff physician at Grand Rounds and a member of the UCSF faculty, consulted on the case of a 40 year-old man in New Jersey who came in to a hospital with flu-like symptoms, and ended up with kidney failure and severe swelling. “The hospital did very appropriate and extensive testing for things like hepatitis, autoimmune diseases, cancer, and blood clots, but they couldn’t find anything,” Shah says.

When the patient went into intensive care, the family reached out to Grand Rounds for help. Within 24 hours, Shah was able to interview the family, obtain medical records and test results, and consult with the patient’s treating physicians. After a family member mentioned a kayaking trip in Florida, Shah thought the patient might have a bacterial disease called leptospirosis. Shah and the treating physicians agreed to put him on antibiotics, and a week later, the patient was discharged from the hospital. ”At the end of the day, medicine is an extremely collaborative field,” he says. “Physicians are typically very happy to receive help.”

They’re also happy to give it, according to Ray Dorsey, a neurologist at the University of Rochester who reviews cases for Grand Rounds. “This is just another means of using tech to increase access to care,” he says.

One of the more complicated parts of building out Grand Rounds’ business was finding the expert physicians that could most help patients, Tripp says. Though the team could easily suggest experts in big cities like San Francisco or Boston, “that doesn’t work for people in Topeka or Anchorage,” Tripp says.

So the company built a 13-factor algorithm to help create a list of the best of the best, evaluating both qualitative and quantitative data. Physician training—medical school, fellowship, internship, physicians doctors studied under and the time period in which you studied—is very important, according to Tripp. But so are observed factors, like the number of procedures preformed and treatment outcomes.

Though Grand Rounds pays the physicians who give patients second opinions, Tripp says some don’t do it for the money. “They either do it for fees, or they do it because they like being part of the club,” he says. “Expert physicians are very pedigree driven.” Plus, specialists don’t always get to see a ton of particular types of cases in the area in which they live. Opening themselves up to a national audience allows them to treat a much larger group, giving them better practice treating specific diseases.

All in all, says Tripp, “I think it’s part of larger healthcare conversation in terms of extending resources and improving access and quality of care. Harnessing the technology we have here can dramatically improve the healthcare landscape.”

 

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