Why specialty care outcomes depend on virtual access to expertise

Even as use of telehealth ramped up during the pandemic, difficulties accessing virtual care and support remain a barrier to the best care for patients facing complex conditions.

Many individuals still struggle to schedule visits with physicians who have specialty expertise, despite the gains made during the pandemic. This is particularly true for those living with chronic, complex conditions such as cancer, chronic obstructive pulmonary disease, epilepsy and diabetes. It’s a scenario that affects not just those living in rural or disadvantaged areas, but even those near a center of excellence who still struggle with identifying and accessing the most appropriate specialist in a timely manner.

In many instances, patients who desire second opinions or treatment from specialists often must travel for one-to-one consultations—usually long distances and at great expense. Further, wait times for scheduling in-person appointments can be lengthy, running into weeks and sometimes even months.

It’s one reason why the Biden administration announced it would distribute nearly $20 million to strengthen access to telehealth services. But telehealth access alone won’t drive marked improvement in specialty care outcomes in these communities and other areas across the nation. What is needed: insight from the right medical experts, anywhere, any time—including for second opinions.

Access to virtual specialty care can reduce misdiagnoses and related costs for providers and health plans. To remain competitive in 2022 and beyond, health systems and payers must provide consumers with on-demand virtual visits with specialists—regardless of location.

Statistics show that one out of 10 patients with cancer, a major infection or a major vascular event, such as a heart attack or stroke, are misdiagnosed each year. These conditions account for 75% of serious harm resulting from diagnostic error, most of which are the result of mistakes in clinical judgment or lack of specialist review. The chances of being misdiagnosed are especially high for people with complex medical conditions: 20% of people with serious illnesses are misdiagnosed, one study found.

By expanding access to virtual specialty care, general providers and systems no longer have to be “all things to all patients.” Instead, they can provide patients with access to world-class, expert medical care that improves health outcomes and reduces costs, regardless of where patients live. This is especially vital for those living with chronic conditions, who consume the largest portion of healthcare resources, as most suffer from at least one comorbidity and are often under the care of multiple specialists.

Further, by supporting options for “tele-mentoring” between specialty care providers and general practitioners—one area of focus under new federal funding—general physicians can gain the support they need to manage patients’ health more effectively. Virtual access to the right specialists also offers the chance to detect potential health problems before they become emergencies, reducing the risk of readmission.

Today, we’re seeing more commercial payers and providers expand virtual options for specialty care and second opinions:

• In 2020, Anthem, Inc., rolled out a concierge cancer care program through which patients may obtain a virtual second opinion from Cleveland Clinic’s expert physicians, including world-renowned oncologists.
• At Penn State Health, the decision to invest in multidisciplinary virtual care for patients suffering from Amyotrophic Lateral Sclerosis, or Lou Gehrig’s Disease, eliminated long travel times and exposure to COVID-19 for vulnerable patients. It also produced health outcomes that are comparable to in-person care.
• At The Clinic by Cleveland Clinic, a virtual second opinions program now includes multidisciplinary case analysis for brain tumors and prostate cancer. This ensures patient cases are reviewed from all angles, providing a higher level of confidence for patients around the medical advice they receive.

By exploring options for virtual specialty care, providers and health plans can help connect individuals with physicians who have depth of experience in treating their condition. The impact: improved health outcomes, reduced costs and greater peace of mind.

Emerging evidence suggests that expanding access to specialty care virtually doesn’t just improve health outcomes and the experience of care. It also makes good business sense.

McKinsey & Company estimates that the United States could save up to $250 billion in healthcare spending by shifting toward virtual care. Much of the savings could be achieved via virtual specialty care, McKinsey data shows.

Virtual access to the right specialists and second opinions also removes barriers to care that prevent individuals from receiving the correct diagnosis. For example, our experience at The Clinic by Cleveland Clinic shows that when patients receive a second opinion for life-altering diagnoses, such as cancer, 28% of patients receive a change in diagnosis, while 72% of treatment plans are modified after analysis. Yet for most health plans and employers, second opinions are still a largely untapped opportunity.

Pairing members with complex medical conditions with coordinated support for medical review—virtually, in partnership with an academic medical center or center of excellence for specialty care—reduces the risk that members will be exposed to unnecessary treatment. It also protects them from higher-than-necessary healthcare expenses while providing peace of mind that they are on the right path for care. For health plans and employers, the right diagnosis through a virtual second opinion equates to better member outcomes and reduced benefits costs.

The potential to more fully incorporate virtual specialty care—including through virtual delivery of second opinions—is significant. By leaning into advancements in virtual care to provide the right care from the right specialists, providers, health plans and employers can help ensure individuals with complex or chronic conditions receive great care—a win-win for all.

Frank McGillin is CEO of The Clinic by Cleveland Clinic.

This article was originally published on Medical Economics®.