Second That

Second-opinion services prove valuable, not only in controlling healthcare expenses, but in bringing employees and their families peace of mind in their decision-making.

By Carol Patton

Last May, The Texas A&M University System decided to try something new in its quest to enhance the health and wellness of its workforce that would be free for employees but wouldn't bust the school's budget. It introduced a free medical benefit to its 27,000 employees and retirees -- a second-opinion program offered by 2nd.MD, based in Houston.

The idea was to help employees who were suddenly diagnosed with a serious or unusual condition but didn't quite know what to do or where to go next. Was the diagnosis correct? What about the treatment plan -- are there better alternatives? Could something else be tried before surgery?

"When [employees] are faced with a critical need, there's no one there to help them find the next [medical] expert," says Kevin McGinnis, executive director of risk management and benefits administration at the university. "We [didn't do this solely] out of financial gain to lower healthcare costs. We really did it . . . to improve [every employee's] health and lifestyle."

As skepticism increases about the value of wellness programs, some employers -- such as Texas A&M -- are turning to second-opinion services. Like many employee benefits, there can be variations in how it works. In some cases, the employer may pick up the entire tab. In other situations, employees may need to come up with co-pays to the second-opinion doctors for expert reviews of their conditions.

Typically, second-opinion doctors from around the country virtually review an employee's case by analyzing MRIs, X-ray scans or other test results and information documented by other doctors about the worker's medical condition.

Within a day or two, the second-opinion doctor may prepare a written report, conduct an online video chat or teleconference with the employee to address his or her diagnosis -- is it accurate, for instance -- and suggest an improved treatment plan. Such initiatives are considered the next evolutionary step toward jointly boosting the quality of healthcare and controlling a company's healthcare spend.

Within the first 40 days of launching the program, McGinnis says, 58 employees were using the second-opinion service.

"If you told me that 400 people would use it in a year; to me, that is a benefit worth having," he says, adding that employees receive medical opinions within 48 hours.

According to 2nd.MD, 40 percent of the first 53 university employees who used its service had been initially diagnosed with musculoskeletal conditions while the remaining were diagnosed with either cancer or metabolic syndrome, a collection of symptoms that can lead to diabetes and heart disease.

McGinnis adds that 37 of the 53 employees believed the service improved their treatment plan and enhanced their understanding of their condition and how to deal with it. Another 10 were referred to a different doctor or specialist who could further address their diagnosis and treatment plan. McGinnis explains that 2nd.MD gathers employee's medical data and arranges face-to-face visits with appropriate medical experts. The service also saved 21 workdays since consults are performed off work hours.

Besides the number of employees using the service, McGinnis says, the most revealing metric was their overall satisfaction. Out of five stars, the average rating for the service was 4.93.

In conjunction with Texas A&M's HR department, the new benefit was kicked off with a press conference featuring an employee from a different organization who shared his experiences with the service. University employees then received an individualized letter from their campus president, an email announcement and a membership card mailed to their home, although a card is not needed to access the service. Another announcement was also placed in the school's internal newsletter.

Still, McGinnis says, nothing sells a program like firsthand experience.

"With 2nd.MD's help, our plan is to identify success stories," he says, adding that marketing the service has to be constant enough so it's not ignored, yet balanced with the school's other benefit initiatives. "That's the selling point of this program -- people faced with a medical situation oftentimes don't think through their options. Hopefully, this [service] will become as second nature for them in times of crisis as reaching for their insurance card."

So far, the healthcare-cost savings from the program's initial six weeks is greater than the cost of the service.

"Based on the metrics provided to us from 2nd.MD, it has made a difference in [healthcare costs], but it's too early in the game to tell," McGinnis says. Nevertheless, as far as he is concerned, any healthcare savings realized by the university takes a back seat to the university's main goal -- high employee utilization and satisfaction of second-opinion services.

Approximately 48 percent of large employers offer second-opinion benefits, according to a survey conducted by the Washington-based National Business Group on Health, says Jennifer Burns, senior manager of healthcare cost and delivery at the NBGH. That number is expected to rise to 60 percent next year.

"Some companies are using the program with advanced analytics or predictive modeling to determine the likelihood of a procedure or surgery [occurring] before it happens . . .,"  she says. "[So HR] can provide just-in-time outreach, education and program awareness so employees know that they might be at risk for a particular procedure and then know that they should be considering a second-opinion service."

However, such services may not be as needed or valuable if the majority of a company's workforce is located in Boston, for example, where there are multiple world-class medical centers and expert opinions are readily available.

Still, the results are hard to ignore. According to 2nd.MD, its service improves treatment recommendations for 68 percent of its 1.27 million members, prevents unnecessary surgeries by 33 percent and saves an average of $3,000 per consult. Likewise, its competitor, Grand Rounds, which serves more than 50 employers, including Comcast and Costco, states that roughly two-thirds of its reviews lead to changes in employee diagnosis or treatment.

Popular, Yet Confusing

Second-opinion services are gaining in popularity, partially due to discrepancies in treatment based on geography. Last year, the Dartmouth Atlas of Health Care, which analyzes the relationship between healthcare spending and outcomes, reported that men in some regions are 15 times more likely to undergo a controversial screening for prostate cancer -- prostate-specific antigen -- than in other parts of the country. The use of surgery to treat men with prostate cancer ages 75 and younger also varied nearly eightfold among regions between 2007 and 2012, from 54.8 in Ocala, Fla., to 479.5 in Munster, Ind.

"Screening and treatment for prostate cancer depends tremendously on where a patient lives," says Dr. Elias S. Hyams, co-author of the Dartmouth report. "The wide variation demonstrates that there is, most likely, over-screening and under-screening, as well as over-treatment and under-treatment."

Despite the fact that second-opinion services are free, many employees still don't take advantage of them, believing they're "cheating" on the doctor who initially diagnosed them, says Burns at the NBGH.

"Marketing and communication materials almost need to give employees permission to get a second opinion," she says. For example, HR can create messaging that asks: 'Do you want to feel secure about your medical decisions and have peace of mind? Here's a service that will help you.' "

Another tactic is to focus on accessibility. Physicians practicing in remote areas may have limited access to the latest diagnostic tools to make an accurate diagnosis or treatment plan. "The second-opinion service can match employees up with a hospital center or teaching medical center that can bring in more experts for that specific condition and use more sophisticated diagnostic [tools] to make a more accurate diagnosis," Burns says.

Although second-opinion services have been around for many years, confusion still surrounds them, says Ron Leopold, national practice leader of health outcomes at Willis North America, a human capital consulting firm in Atlanta and insurance broker that sells second-opinion programs.

"Sometimes, people kind of park the services, the capabilities, the function in some of the old managed-care-precertification measures, which is totally the wrong way of thinking about them," he says, explaining that, in the past, precertifications were used to manage overutilization of specific services. "They morphed from something that was punitive and [focused on] cost control to [the] recognition that, in many cases, [employees] are not availing themselves of the right level [of care] or provider . . . . This [service] becomes a matter of giving everybody access to an informed advocate or expert clinical opinion."

When using such services, Leopold says, HR must identify which employees are devouring most of the healthcare dollars. Based on Willis' and industry research, he adds, 70 percent of a workforce population drives 7 percent of the costs; 25 percent is responsible for 35 percent of the costs, and the remaining 5 percent eat up 58 percent of the costs.

"So as [you] start to evaluate the people who drive the lion's share of cost, you start to realize that they are the people with medical complexity, medical uncertainty, multiple diagnoses, medical severity, and certain surgeries and procedures," Leopold says. "More enlightened employers are recognizing that, if they could get to those particular individuals with solutions that meet their particular needs, that may be a very effective way [of] targeting exactly where the money is [spent]."

Although these benefits are an additional spend, he says, they are attracting more interest as employers get "smarter" about healthcare costs and risk-stratified care management and work with second-opinion vendors to mine claims data to identify employees who are good candidates for the service.

Leopold suggests that HR promote the program to both employees and their spouses through multi-communication channels and offer case illustrations or scenarios that employees can identify with, which will prompt them to use the service when needed. However, he says, refrain from marketing it as an insurance-carrier initiative to avoid building employee skepticism. Although companies offering second-opinion services usually work independently from carriers, he says, many workers will believe that their key goal is to prevent insurance companies from paying for needed surgeries or other costly procedures.

"I am extremely bullish on this category of vendor," says Leopold. "[These services] are very elegant vendor solutions that exactly appeal to the very people [HR] is trying to impact."

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