Virtual Second Opinions to Reduce Misdiagnoses, Improve Costs After Pandemic

Frank McGillin, CEO, The Clinic by Cleveland Clinic, discusses the importance of reducing misdiagnoses to contain costs, as well as how the shift to virtual care brought on by the pandemic can ensure patient access to second opinions.

Read the full transcript: 

Hi, I'm Frank McGillin. I'm the CEO of The Clinic by Cleveland Clinic. We're the joint venture between Cleveland Clinic and Amwell, and our focus is unlocking access to the world's best medical expertise leveraging digital technology.

How prevalent are misdiagnoses? What causes misdiagnoses and how do they impact patient outcomes?
These diagnoses are more common than you think. One out of 10 people diagnosed with a cancer, a complex coronary or cardiac condition will be misdiagnosed in their lifetime. If you think about the case of someone dealing with a cancer diagnosis or mitral valve issue, the misdiagnosis could be pretty significant in terms of quality of life. So that's why the second opinion really is a great opportunity for people to make sure that they're on the right treatment path, and that they're understanding what their options are. Because many times even if the diagnosis is correct, we find about two thirds of the time there's potentially an alternative treatment pathway that may have better outcomes, maybe less invasive, maybe less costly.

Despite all the advances in science, there's still a lot of medicine that they say it's art and science and still a lot of it is art. One statistic I saw recently, there's 10,000 diseases in the world, but only 200 to 300 symptoms, so it's a bit of a guessing game. Beyond that, you have to deal with different biases. Physicians are normal, they're people, so there's often biases, heuristics where physicians will take a shortcut. "Oh, I know Frank, he has this x, y, z profile," and then jump ahead. The beauty of a second opinion, where it's an objective third party expert, is they're starting with a clean sheet of paper. They're really looking at it and saying, "Okay, what might have been missed? What are some of the things I need to look at based on this patient's background?

Can you comment on the costs associated with misdiagnosing a patient?
Costs are significant. There was one study that showed the cost for a health plan per hundred thousand members could top $65 million. It adds up pretty quickly. It's more than just the human toll, it's also the financial toll. We find that, we did some research looking at second opinion cases we did in 2021, and we found that on average, we were saving health plans about $12,000 per diagnosis.

How can misdiagnoses be reduced?
I think the first is getting to the right expert. There's different types of second opinion programs out there. There's the traditional, where you're based in Boston or you're based in New Jersey and you find another doctor in your area. That could be convenient, although oftentimes just finding the right physician isn't convenient. There are other commercial programs that are out there that try their best just to connect you with an expert physician. I think what we've developed is very unique. We were able to tap into the 3500 specialists at Cleveland Clinic and tap into 550 different subspecialties.

The beauty there is that if you have a very specific form of breast cancer, for example, or a very specific heart valve issue, we're able to match you with a physician that really is an expert in that area and just focuses on a very narrow disease state. You're seeing the best options that are available for you, really understanding whether there's clinical trials going on in the case of a cancer, maybe again, different procedures, different treatment protocols that could be either cheaper or less invasive or lead to a better quality of life.

Where do you see the future headed as the pandemic continues changing how we approach patient care?
Well, I think patients in general are seeing that telehealth offers an option that they like. If you think of the traditional model it was, if I have to go see my doctor, particularly a specialist, I'm taking half a day off from work for likely a 15-minute interaction. We see a future where it's really all about hybrid care. There are times that face-to-face, that physical interaction's required, but there are other times where it's faster, it's easier, it's potentially cheaper to leverage technology in telehealth. We see that becoming more and more common. Our feedback from patients is that upwards of 90% really like the virtual approach and the fact that it doesn't matter whether they're a patient based in Kansas City or Kuala Lumpur, they're able to access that best doctor.

Is there anything else you’d like to add?
One additional point I'd make is for health plans or employers that are exploring opportunities in leveraging an expert second opinion program is to really think through both the patient experience as well as the financials. I think the best programs will deliver a great experience for your member and for your employee. A great program will also lead to really the clearest, most precise, and most appropriate diagnosis and pathway for that patient, ultimately leading to better outcomes and saving money.