The evolving business of virtual second opinions

Case in point: The Clinic, a joint venture between Cleveland Clinic and telehealth giant Amwell, launched in 2020 just before the pandemic began.

• The idea was to pair the Cleveland Clinic brand with Amwell's virtual tools and its existing connections with private insurers to make it easier for patients to get their records reviewed, said Frank McGillin, CEO of The Clinic.

State of play: Patients customarily have to run the traps to get relevant health records and test results to a new doctor and may endure extended wait times, McGillin said. And on the backend, some providers still rely on large binders of physical records and scans that have to be lugged around.

• The Clinic works like a pricey concierge service that gathers records in digital form and pairs patients with a specialist who reviews the case and typically delivers a second opinion within two weeks.
• The speed and convenience can be valuable in the case of a cancer diagnosis or in a situation where the course of treatment isn't clear. But for now, patients not referred by one of The Clinic's insurance partners have to pay close to $2,000 out-of-pocket, not including any additional tests or services.

How it works: Patients register on The Clinic's website, then have a live intake interview with a nurse care manager. Once patients give their consent, The Clinic collects the relevant medical records for review.

• Cleveland Clinic specialists deliver a written report with a video consultation after reviewing imaging scans and lab tests.
• The Clinic was already offering second opinions and digitizing clients' medical records when the pandemic hit, giving it a head start as social distancing measures kicked in and in-person care dropped off, McGillin said.
• "Digitizing it helped us survive because clearly blue binders weren't going to work," he said.

The big picture: This was part of the bigger expansion of virtual specialty services during the pandemic, said Ido Schoenberg CEO of Amwell.

• "The aversion against connecting digitally is really very, very different today than it was," Schoenberg said.
• Other virtual care companies' offering second opinions were boosted by the pandemic-driven explosion in telehealth. Health benefits company Accolade acquired virtual second opinion startup 2nd.MD and covers more than 9 million individuals.
• Large insurers like Elevance Health, formerly known as Anthem, have begun offering second opinion services to major national employers, Schoenberg said. Patients can access the services from around the world, making it easier for those in underserved areas to get a second opinion without having to travel.
• "It’s no longer a single soldier patient trying to find their way in the maze of options. It’s becoming part of a normal benefit," Schoenberg said.

The business case: So far, The Clinic estimates it's been able to save $65 million per 100,000 health plan members.

• More than 70% of the time, the second opinion program eliminates unnecessary tests or procedures or otherwise modifies a diagnoses or treatment plan, McGillin said, citing average savings of $12,000 when there's a change in diagnoses.
• One common example is disagreeing with a recommendation that a patient get spinal fusion surgery when physical therapy would be more appropriate, he said.
• While McGillin said the second opinion service don't steer patients to a particular facility, the health system does earn new patients through the program.
• "It does help achieve that mission as a feeder for 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-paying patients is $1,850.

• Studies generally find 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 can be confusing disagreements between doctors, and sometimes there just won't be a clear answer.

What to watch: The expansion of virtual specialty care programs that offer second opinions for chronic care management.

• McGillin said the program is likely a starting point for Cleveland Clinic "as we build on this approach, to rethink the delivery of specialty care outside the four walls of the hospital."
• He expects better management of large populations with chronic conditions, like heart failure, will be the next step.