Industry Voices—How 2nd opinions can save payers and satisfy patients

Payers face a multifaceted challenge of managing rising healthcare costs while also meeting the heightened expectations of consumers who expect medical interactions to be as personalized and convenient as ordering pizza from an app. To succeed in this competitive healthcare environment, payers must provide members with both value and satisfaction.

New data reveal that a single solution could fulfill both components of this goal for payers. Incorporating virtual second opinions into benefits plans presents a huge opportunity to improve diagnostic accuracy and provide appropriate care—especially for the most complex and costly conditions. This can save payers from costly misdiagnoses while helping patients avoid unnecessary medical interventions.

Here’s how second opinions can alleviate payers’ cost concerns while also appeasing patients’ expectations for personalized, high-touch care.

The savings of second opinions

To measure the financial impact of virtual second opinions (VSOs), The Clinic by Cleveland Clinic recently commissioned a third-party analysis of patients who pursued a second look last year. According to the data, VSOs decreased medical costs by an average of $8,705 per patient.

By connecting patients with Cleveland Clinic specialists to reevaluate serious (and potentially costly) medical conditions, The Clinic’s VSOs recommended a different diagnosis or treatment plan in about two-thirds of cases. They recommended hospitalization 62% less often than the original care plans. And, in cases where the initial recommendations included surgery, the VSOs suggested a less invasive alternative 85% of the time. By realigning treatment plans toward more appropriate care, VSOs help patients (and their health plans) bypass the unnecessary costs of hospitalization and surgery.

These savings are accentuated in high-cost cases. When the patient’s initial care recommendations cost more than $10,000, the VSO saved more than $100,000 per patient, on average. Savings also vary by specialty—averaging more than $28,000 per patient with a musculoskeletal condition and more than $8,000 per case related to a cardiovascular condition. Overall, the study found positive savings associated with all the specialties studied.

Clearly, the reevaluation of complex diagnoses and costly treatment plans through VSOs can be valuable for payers that prioritize appropriate, cost-effective care. But how do these second opinions contribute to payers’ other priority of patient satisfaction?

The power of the patient experience

To understand consumer perceptions around VSOs, The Clinic by Cleveland Clinic commissioned a separate third-party analysis in late 2023. This research revealed that an overwhelming majority of patients would consider a second opinion—including 76% of those who had never had a serious health condition before and 71% of those who had. An even higher percentage (78%) said they’d be likely to seek a VSO if their employer offered it as a health benefit—a noteworthy takeaway when reevaluating plan benefits.

As patients become increasingly frustrated with the current state of healthcare, which often leaves them with limited access to and long waits for doctors, this study shows what patients truly value: personalized attention, convenient access to specialists and compassionate concierge-style care—all of which a VSO delivers.

In The Clinic’s consumer perceptions survey, 56% of respondents noted that a key reason for seeking second opinions was accessing a specialist who could dedicate time and resources to their care—without having to travel to a far-off facility or waste time in a waiting room. More than half of the respondents (52%) mentioned reduced travel requirements as a top factor in considering second opinions. Coincidentally, analysis from The Clinic shows that VSOs can save patients an average of $1,000 in travel and related costs associated with seeking specialty care.

By providing personalized and convenient care, VSOs present an appealing alternative to patients. These encounters can boost patient satisfaction, contributing to improved health outcomes and adherence to treatment plans—ultimately helping reduce healthcare costs.

Connecting the benefits

Here’s an example (PDF) to illustrate these benefits in action. Recently, a man with a history of rheumatoid arthritis had an annual chest X-ray that revealed an aortic root aneurysm that, his doctor worried, could cause life-threatening bleeding or blockage. The local cardiothoracic surgeon recommended aortic root replacement surgery, which typically requires six to 12 weeks of recovery time.

The man decided to seek a VSO through The Clinic by Cleveland Clinic, consulting with a cardiologist and cardiothoracic surgeon from Cleveland Clinic’s world-leading heart center. After reviewing the imaging and re-measuring the aortic root, the physicians determined that surgery wasn’t necessary after all and recommended routine surveillance instead. Not only did this second opinion save the patient from a $213,000 procedure, but it saved him the distress of undergoing an invasive heart surgery with a lengthy recovery.

Second opinions from expert specialists lead to significant savings, and the peace of mind that patients receive on their care journey is invaluable. As more healthcare payers evaluate the member experience alongside cost considerations, the best solutions will be those that combine savings and satisfaction.

Frank McGillin is CEO at The Clinic by Cleveland Clinic, a joint venture between Cleveland Clinic and Amwell that aims to expand access to healthcare expertise through digital technology. A provider of virtual second opinions, The Clinic offers secure video consultations, digital record collection and concierge-level service to patients and health plans.