Virtual Second Opinions Improve Access and Diagnoses
By Matt Phillion
The desire for a second opinion when faced with a major medical decision is natural, and asking for another set of expert eyes on your diagnosis when the next decision will have a major impact on your life and health is not a new concept. But for many, getting that second opinion, especially when the patient is not in a geographic area with a wealth of healthcare professionals and specialists, can be difficult.
To open up the option for more people to engage with second opinions, The Clinic by Cleveland Clinic is offering virtual second opinions. The Clinic is a joint venture that combines the clinical expertise of Cleveland Clinic with Amwell’s telehealth platform. A recent analysis of the results of The Clinic’s virtual second opinions has found an average savings of $8,700 in cost per patient, but beyond the financial aspect, the analysis also uncovered that patients are often saved from unnecessary procedures by discovering less invasive or life-altering options to treat their condition.
The independent, third-party analysis found that 67% of The Clinic’s virtual second options recommended a diagnosis or treatment plan change, and in cases where the primary treatment plan included surgery, the virtual second opinion recommended an alternate treatment 85% of the time. These second opinions also recommended hospitalization 62% less often than the primary treatment plan.
“The inspiration for this came from the vision of how the Cleveland Clinic has been number one in cardiology for 29 years, it’s one of the top academic medical centers globally, but to some extent it’s limited by its geographical footprint,” says Frank McGillin, CEO of The Clinic by Cleveland Clinic. “If you’re in certain cities it’s easier, but anywhere else in the world, you’re unlikely to have access to world-class experts.”
The concept was to unlock access to Cleveland Clinic expertise regardless of where the patient is in the world who needs it, McGillin explains.
“The concept of second opinions has been in place forever, asking peer-to-peer, ‘What do you think about this case?’ Or for patients, you’ve got this diagnosis, you need a heart valve replaced or you have a cancer diagnosis, and you want to talk to a specialist in the ideal treatment path,” says McGillin. “We’ve made it easier to access this expertise in a process that’s very patient-centric.”
A team of nurses conduct an intake process with the individual, get an understanding about the current diagnosis, and run through questions about who they’ve already been working with, gain access to their medical records, imaging, pathology reports, anything else that might be needed to assess their condition. The patient is then matched with a Cleveland Clinic specialist or subspecialist who is best suited to their individual needs.
“The typical layperson doesn’t know exactly who they need to talk to about their cancer diagnosis. Part of our value is matching them to the right specialist,” says McGillin.
The specialist then reviews the case history, medical records, pathology, and so on, and meets with the patient virtually to review their case. The turnaround time is short, usually three to five days after they get the records.
“Time is of the essence,” McGillin notes.
Patients find the program one of two ways. Often, it’s a direct-to-consumer approach, where the patient reaches out and schedules a consultation. But McGillin notes that health plans, care benefit companies, and large employers are also starting to provide second opinions as a benefit to their members and are making use of the program as well.
“It’s a great benefit for people who need expert opinions. It saves those plans and employers money by eliminating unnecessary procedures, but we’re not denying care. It’s about finding the best care options for the individual,” he says.
The Cleveland Clinic’s physicians are on a staff model, so there’s no financial incentive to recommend one treatment or procedure over another, enabling them to focus on the needs of the patient, says McGillin.
“Sometimes the best option might be a more invasive or significant procedure, and other times it’s a more conservative approach,” he says.
The virtual nature of the program also eliminates one of the biggest barriers to getting a second opinion: wait times.
“Even in locations where you can find the specialists you need, the wait time for an appointment can be three months,” he says. “Even in areas with academic medical centers it’s generally not easy to get in. But for someone in a rural area—we work with clients to help their employees overseas, for example—we can really break down that time/distance barrier to access.”
Changes in technology open doors
It’s been frequently said that telehealth jumped forward 10 years in 10 months during the pandemic, and this shift in culture has helped with the potential for concepts like virtual second opinions.
“Prior to the pandemic, the limits of telehealth weren’t the technology, it was user and consumer expectations, and a bit of physician expectations and billing,” says McGillin. “There were a few things getting in the way of widespread adoption and the pandemic wiped those off the board.”
While telehealth overall has cooled down somewhat, for certain use cases, McGillin notes, it really is an ideal option.
“It helps address a mismatch of supply and demand,” he says. “With second opinions, you’re dealing with a shortage of specialists and often geographically your available specialists don’t align with your needs.”
Because all imaging is now digital, pathology results are digitized, and the electronic medical record is digital as well, the speed of access is such that getting a second opinion no longer needs that in-person interaction.
There are some barriers to overcome, of course: each state having its own regulatory requirements for practitioners is something that the program itself works through ahead of time. This ensures they’re operating at the highest level of compliance but also to protect the providers and patients so they don’t have to stress about regulatory issues by staying ahead of those questions.
More confidence, better satisfaction
This type of program only works if the patients feel good about it and the clinicians involved feel engaged and excited to support it, McGillin says.
“One of the benefits we hear from patients is the level of confidence they have: two-thirds of the time there’s a change in diagnosis, but even for the third who are on the right path, there’s a level of reassurance of knowing you’re on the right path that gives you the confidence to move forward,” says McGillin. “You don’t want to roll into surgery wondering, ‘Is this the right thing to do?’”
Meanwhile, on the provider side, 90% of the clinicians involved want to continue to do so.
“We try to make participating really easy for them,” McGillin says. “If you look at pre-digital second opinion programs, you’re talking about binders with 50 pages of medical records to review by hand. A digital workflow removes some of that pain.”
Additionally, the cases themselves are interesting. Patients seeking additional opinions often have complex cases that provide a challenge for leading experts to engage with. And while the intellectual challenge is a benefit, it goes beyond just the cerebral, McGillin notes.
“From the human side, these specialists realize this enables them to provide help to people who could not get help elsewhere,” he says. “We have a specialist in rare pediatric cancers who tells us he sincerely wants to help these families. It’s a way to give back to the patient and make a difference.”
McGillin sees a bright future for virtual second opinions’ growth, but beyond simple expansion, the stories about who the program helps on a human level cannot be overlooked.
“We have a woman with a dire diagnosis requiring a heart transplant. She went through our program and the physician who looked at her case said she was a candidate for stenting,” he says. “Not only were there less-invasive options out there, the cost was roughly $200,000 less and it also spared her lifelong immunosuppressant treatments. She didn’t have a bad diagnosis—I truly believe the physician was trying to do their best work—but if you look at the disparity in the number of high-risk cases you see at a major medical center versus a community hospital, that level of experience and expertise opens up your perspective.”
McGillin hopes to see a drive in both investment and policy toward further focus on patient-centric care.
“I think too often healthcare loses sight of the individual at the other end of the experience,” says McGillin. “To me, it’s about shifting the focus to how do we deliver the best care out there at the most affordable standpoint.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.