Beyond urgent care: Why virtual second opinions are telehealth’s next value differentiator

For years, healthcare stakeholders viewed telehealth as the stuff of one-time visits for patient urgent care needs without the expense or the inconvenience of a facility visit.

Now, the shift to virtual care during the pandemic has prompted the industry to consider: Where is telehealth headed—and how can we optimize its value?

For health plans, who have often been siloed as separate decision makers in the care continuum, data demonstrates the need to embrace virtual second opinions for complex health diagnoses. Adopting this approach not only offers strong potential to improve quality of care and the member experience, but also to reduce healthcare costs for plans and members. This is especially critical as payers become more interoperable with the rest of the industry.

The Business Case for Virtual Second Opinions

The depth of misdiagnoses in healthcare is staggering—and it comes with a substantial cost, both human and financial.

Most Americans will be misdiagnosed at least once, research shows, including 21% of people with serious illnesses. At The Clinic by Cleveland Clinic, our experience shows:

• When patients receive a second opinion for life-altering diagnoses, such as cancer, 28% of patients receive a change in diagnosis.
• When reviewed by expert physicians, 72% of treatment plans are modified after analysis.

These are just some of the reasons why the market for second opinions in healthcare is soaring, projected to reach $7 billion by 2024, up from $2.7 billion in 2019. Yet for health plans, second opinions remain a largely untapped opportunity. Most health plans do not have a ready off-ramp for members who wish to get expert confirmation of their diagnosis and treatment plan. Meanwhile, many members are uncomfortable initiating this discussion with their physicians—even when facing a life-altering condition.

Virtual second opinions change the game. With the proliferation of telehealth during the pandemic, health plans now have more options for pairing members with coordinated support for medical review. Relaxed telehealth licensing rules also make it easier to close gaps in medical expertise by empowering health plans to connect members with high-demand specialists from anywhere in the world. It’s a model that strengthens value while creating a better experience for members with complex care needs.

Designing a Value-Added Approach

Members who receive a life-altering diagnosis such as cancer want the assurance that they are making the right decisions for their health. Digital transformation gives health plans new avenues for connecting members with experts in their specific medical condition. For members who live in rural areas or communities where access to specific specialties is limited or unavailable, virtual consultations help close gaps in care, providing peace of mind while eliminating the risk of unnecessary treatment.

But the availability of a telehealth platform alone won’t provide the value that health plans and members seek. The right mechanism for virtual second opinions should incorporate these elements.

No. 1:Deep access to medical expertise. Medicine has become so specialized that physicians must continually stay on top of the current treatment strategies in their discipline. The right virtual second opinion offering will match members with medical experts who are highly experienced in their condition—for example, an electrophysiologist for a member with a cardiac arrhythmia rather than a cardiologist. In some instances, the expertise members need might not be available anywhere nearby, making virtual second opinions a convenient and cost-effective solution.

The business case for specialized virtual support is strong. Three-in-four employers say they will ramp up the move toward value-based care models over the next three years. In this environment, digital centers of excellence (DCOEs) will emerge, marked in part by their ability to match members with the expert best suited to review their case—and not just locally.

No. 2: Speed to insight. If the expertise is great but the experience is subpar, the experience is what members will remember over the long run. That’s why speed to insight is critical: When members are struggling with a medical challenge or are about to make a major decision in their health journey, they need fast access to experts who can answer their questions and provide appropriate guidance.

When investing in a virtual second opinion offering, make sure that member access is simple, efficient, and effortless. Wait times for intake appointments should be short—ideally, available on demand. Further, workflows should enable members and their local providers to receive a detailed analysis within two weeks.

No. 3: Results members can trust. Care is only as good as it is reliable. In spite of the advancements made in medicine, one out of 10 patients with cancer, an infection, or a major vascular event, such as a heart attack or stroke, are misdiagnosed each year. These conditions—commonly called the “Big Three”—account for 75% of serious harm resulting from diagnostic error. In 85% of these instances, failures in clinical judgment are to blame.

To avoid scenarios such as these, well-designed virtual second opinion programs incorporate multidisciplinary case analysis. They also give members the opportunity to speak by video conference directly with the expert physician on their case.

By bringing the right expertise to bear—virtually—health plans can better ensure that members with complex conditions receive the right diagnosis and a treatment plan based on the best evidence and experience available.

Frank McGillin is CEO at The Clinic by Cleveland Clinic.