Illustration: Sarah Grillo/Axios
There are few things more stressful than receiving a serious medical diagnosis, but pandemic-era changes to virtual care are prompting more patients to get a second opinion without leaving home.
Why it matters: The telehealth explosion made it easier to get advice from top doctors across the country, and for health systems to grow business beyond their physical footprints and even treat some of the people seeking consultations.
Case in point: The Clinic, a joint venture between the Cleveland Clinic and telehealth giant Amwell, launched in 2020 just before the pandemic began.
- The idea was to marry the Cleveland Clinic brand with Amwell’s virtual tools and its existing connections with private insurers to make it easier for patients to review their records, said Frank McGillin, CEO of The Clinic.
Status of the situation: Patients routinely have to cheat to get relevant health records and test results to a new doctor and can endure long wait times, McGillin said. And on the back end, some providers still rely on large folders of physical records and scans that need to be transported.
- La Clínica functions as an expensive concierge service that collects records digitally and matches patients with a specialist who reviews the case and typically provides a second opinion within two weeks.
- Speed and convenience can be valuable in the case of a cancer diagnosis or in a situation where the course of treatment is unclear. But for now, patients who aren’t referred by one of The Clinic’s insurance partners have to pay about $2,000 out-of-pocket, not including additional tests or services.
How does it work: Patients register on The Clinic’s website and then have a live intake interview with a nurse care manager. Once patients consent, the Clinic collects relevant medical records for review.
- Cleveland Clinic specialists deliver a written report with a video visit after reviewing imaging scans and laboratory tests.
- The Clinic was already offering second opinions and digitizing clients’ medical records when the pandemic hit, giving it an advantage as social distancing measures were implemented and in-person care was reduced, McGillin said.
- “Digitization helped us survive because clearly the blue folders weren’t going to work,” he said.
The panorama: This was part of the largest expansion of virtual specialty services during the pandemic, said Ido Schoenberg, Amwell’s chief executive officer.
- “The aversion to connecting digitally is really very, very different today than it was,” Schoenberg said.
- Other virtual care companies offering second opinions have been boosted by the pandemic-fueled explosion of telehealth. Health benefits company Accolade has acquired virtual second opinion startup 2nd.MD and covers more than 9 million people.
- Large insurers like Elevance Health, formerly known as Anthem, have begun offering second opinion services to major national employers, Schoenberg said. Patients can access services from around the world, making it easy for those in underserved areas to get a second opinion without having to travel.
- “It’s no longer a single patient soldier trying to find its way through the maze of options. It’s becoming part of a normal benefit,” Schoenberg said.
The business case: So far, The Clinic estimates that it has been able to save $65 million for every 100,000 health plan members.
- More than 70% of the time, the second opinion program eliminates unnecessary tests or procedures or changes a diagnosis or treatment plan, McGillin said, citing average savings of $12,000 when there is a change in diagnosis.
- A common example is disagreeing with a recommendation that a patient have spinal fusion surgery when physical therapy would be more appropriate, he said.
- While McGillin said the second opinion service doesn’t refer patients to a particular center, the health system wins new patients through the program.
- “It helps achieve that mission by feeding more patients, which is absolutely a good business opportunity,” he said.
Yes, but: It’s still a premium offering for most, requiring patients to pay out of pocket rather than serving as a reimbursed visit. The cost for self-pay patients is $1,850.
- Studies generally find that the cost-effectiveness of seeking a second opinion varies greatly by patient group and specialty.
- Patients may not like the answer they get from a second opinion, there may be confusing disagreements between doctors, and sometimes there just won’t be a clear answer.
What to see: The expansion of virtual specialized care programs that offer second opinions for the management of chronic care.
- McGillin said the program is likely a starting point for the Cleveland Clinic “as we develop this approach, to rethink the delivery of specialty care outside the four walls of the hospital.”
- He hopes the next step will be better management of large populations with chronic conditions, such as heart failure.
