Photo: Courtesy The Clinic by Cleveland Clinic
The Cleveland Clinic’s virtual second-opinion program has led to avoidable costs for misdiagnosis of about $65 million annually.
This is an estimated $65 million saved per 100,000 health plan members, said Frank McGillin, CEO of The Clinic by Cleveland Clinic. Typically, the virtual second opinion is a premium benefit health plans are offering, he said.
The digital, virtual solution was launched in the fall of 2020 as a joint venture between the Cleveland Clinic and Amwell, a telehealth company. But the concept began pre-pandemic, McGillin said.
Even as telehealth flexibilities opened up during the pandemic, the service offered by The Clinic at Cleveland Clinic is not considered a traditional telehealth visit, McGillin said. It’s not a reimbursed visit, but rather, it’s self-pay, or it’s a premium offering by the health plan. Patients can access the service from anywhere.
Unlike other virtual programs, The Clinic by Cleveland Clinic is unique in its network of about 3,500 physicians at the Cleveland Clinic, McGillin said. In some cases, the physician may identify a treatment option that’s not available to the patient locally but is available at the health system. In some cases, care is transferred to the Cleveland Clinic.
Also, the program targets the patient experience by making it easy for patients to access that second opinion, he said.
It has taken the best the academic medical center has to offer and made it broader, McGillin said.
WHY THIS MATTERS: HOW IT WORKS
Patients register online for a virtual visit with a nurse case manager, who then collects the medical records for a medical expert at Cleveland Clinic to review.
In about 28% of cases reviewed, there is a change in the diagnosis; in about 72%, there is a change in the care pathway, according to McGillin. Sometimes physicians recommend a more expensive alternative treatment, he said.
However, he said, “In the aggregate, it saves health plans money.”
THE LARGER TREND
The concept of the program began pre-COVID-19, but when the pandemic surged, The Clinic at Cleveland Clinic enacted a specific COVID-19 program.
“We thought a lot about second opinions around that,” McGillin said. “We found it really is the life and death situation.”
The program has expanded globally in a relationship with a health plan in China, and it has launched a specialty program focused on cancer.
A study by the Washington Health Alliance released by The Clinic at Cleveland Clinic looked at the cost of what was deemed unnecessary testing and procedures. It found that more than 622,000 patients in the state of Washington underwent an unnecessary test or procedure in a one-year period, costing an estimated $282 million.
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