At The Clinic by Cleveland Clinic, a New Look at Second Opinions

A survey commissioned earlier this year by The Clinic by Cleveland Clinic and conducted by Acumen Marketing Research, found that, while 71 percent of respondents who have experienced a serious health condition have considered obtaining a second opinion, only half have done so. Among those who never received a second opinion, perceived cost, unfamiliarity with the specialist, lack of specialists in their area, and lack of time were cited among perceived disadvantages. But when introduced to the option of a virtual second opinion from Cleveland Clinic, 89 percent of respondents indicated that they would be somewhat or very interested in obtaining one if faced with an important medical decision. In that context, 52 percent of respondents noted that the elimination of travel time and expenses was a key driver of their interest in a virtual second opinion, which can significantly alleviate cost concerns; while 56 percent noted that a key driver of considering a second opinion is that the specialist takes time to fully understand their medical situation and diagnosis prior to the consultation, and 78 percent said that they were likely to seek a second opinion if the service was offered as a benefit by their employer.

A secondary learning also emerged as respondents continually prioritized the benefits of a faster, more high-touch approach to care. While 50 percent of the respondent sample was unaware that concierge health services were available to them, 62 percent said the most appealing aspects of such a service were fast and easy access to a doctor, while 57 percent reported that minimal wait times were the most appealing factor.

At the time of the release of those findings in February, Frank McGillin, CEO of The Clinic at Cleveland Clinic, said that “The findings from the survey clearly underscore multiple healthcare challenges patients are facing. Speed, cost and quality are always top-of-mind these days, but in the case of a life-altering diagnosis when every moment counts, a delay in getting an appointment or a lack of access to specialty care can change the course of a patient’s future. When they need it most, patients crave the direct, hands-on attention of a qualified medical specialist, and they should never have to settle for less. Creating a faster, more convenient way for patients to obtain that specialized care not only goes a long way in ensuring peace of mind, but also in improving outcomes,” he added.

The Clinic by Cleveland Clinic—which was launched in January 2020—offers this description of its mission, on its website: “The Clinic was founded for life-changing moments. For a diagnosis of cancer. For a decision about joint replacement. For a concern about cardiac care or a question about a chronic condition. For when people need answers they can trust, and they don’t have time to waste. Our vision is to unlock access to the world’s best medical expertise. Because in a life-changing moment, the information you have can make all the difference. The Clinic is a joint venture of the world-renowned Cleveland Clinic and telehealth leader Amwell. We deliver on our vision by extending the reach of more than 3,500 expert physicians beyond the hospital walls to the comfort of home. We are a team of innovators, clinicians, advocates, and doers. And we believe people should have peace of mind about their health without the heavy lifting and seemingly endless waits of the typical health care experience.”

Per all this, McGillin spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the current moment, and what can be learned from the survey results. Below are excerpts from that interview.

How big is your operation at The Clinic by Cleveland Clinic?

On the one hand, we’re still very much in the startup phase. We have about 3 million covered lives that are accessing the Second Opinion program through their health plan or employer, or available globally via self-pay. There’s also a self-pay component in the U.S., around half. And we have about 50 staff onsite, but we’re also constantly accessing specialists from among Cleveland Clinic’s 3,500 specialists.

Why did you decide to do the survey?

One of the challenges is that a second opinion is something you don’t do all that frequently, but when you do, it adds tremendous value. And we wanted to know how people thought about second opinion service or a concierge service.

Do you see those two concepts as being closely aligned conceptually?

If you were to draw a Venn diagram, there’s a significant conceptual overlap. The typical patient has just been told they have cancer or need an invasive cardiac procedure, or something similar. And they need to access that second opinion pretty quickly. And we realized that tracking down medical records was important, and was a tremendous burden, and where do patients start? And finding the specialist for a second opinion, is also difficult to access, especially in an expedited way? And how do you begin to think about that matching? So maybe you have an uncle who’s a cardiologist, but is he the right person? And so we hold a person’s hand a long the way to quickly get to that diagnosis, as well as to help people understand their path. So in the end, it is a form of a concierge service.

Were any of the survey results surprising to you?

There were some surprises, and some things that made sense. One that made sense is the idea that I can make it easy to access a specialist for a second opinion, and that people would be open to it. But what was surprising was that fewer than half who were given a serious diagnosis, actually accessed a second opinion. The survey points out some of the reasons: it’s not easy, it’s a foreign land for most people, and there is expense related to accessing that second opinion. One of the other data points was this one: 78 percent would seek a second opinion, if it were available through their employer’s health plan. But the obstacles include, I don’t know where to start; I can’t travel to access that second expert; I don’t know where to begin; or that potential cost impact.

Are there any health equity issues involved in all this?

We believe that virtual second-opinion programs can reduce health inequities; part of it is that it’s an important value-add in health plan design, as opposed to just a nice-to-have. And if you think about the geographic limitations facing people in rural areas, helping people with geographic obstacles.

What has the trajectory been like so far?

We’ve seen significant growth year over year in the program. And it’s been interesting looking at the various stages of the pandemic. You’re correct that early on the pandemic, elective surgeries were pretty shut down. But the early phase did heighten the interest in virtual access to care and expertise. And attitudes have changed about virtual visits, both among patients and physicians. So the pandemic changed the level of openness to virtual interaction among patients and physicians. And health plans and employers see the convenience, but they also see the value and the return on investment, because the best care is also the most cost-effective care, and that’s what we’re all about.

How do you expect The Clinic’s operations to evolve forward over the next few years?

We think there’s an opportunity here, and our vision is around how we can build on this, the fact that we have access to 3,500 of the most expert physicians in the world, so we see many opportunities to help many more people.

Is there anything that you’d like to add?

I would just close by saying that there’s a gap between utilization and the potential to help people. Our learning has been that if you can make it easy for people, and reduce friction, reduce travel, it will ultimately improve clinical outcomes and reduce the cost of care.