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The best second-opinion programs are designed to drive better outcomes for patients
The practice of getting a second opinion before undergoing major medical treatment is probably as old as professional medicine. Employers, health plans and individuals have long sought out a second opinion when faced with surgery or some other serious course of treatment to make sure it’s both necessary and the right action to pursue.
For many years, employers have mandated the use of second opinions when costly surgeries or speculative treatments were prescribed, even to the point of imposing penalties on employees who did not comply.
However, in this era emphasizing evidence-based medicine and consumer-directed health care, second opinions are taking on a new role. “Today, the best second-opinion programs are designed to drive better outcomes for patients by steering them to centers of excellence,” said Bill Carew, managing principal with Digital Benefit Advisors in Hartford, Conn. The goal for employers is still to save money, but most employers now strongly encourage the use of second opinions rather than making them mandatory, he said.
Evaluating Costs and Outcomes
The question of whether second opinions save money or improve quality of care and outcomes is a murky one. “The concept of second opinions had fallen out of favor for a period, in part because of a tendency for the second opinions to confirm the original diagnosis and add unnecessary complexity,” said Mike Thompson, a principal with PricewaterhouseCoopers in New York. But as employers emphasize consumer-directed health care and urge employees to take a more active role in health care decision-making, second opinions are making a comeback.
Yet questions about the benefits of second opinions remain largely unanswered. Quite simply, “there is very little information available about what impact second opinions have or how often a second opinion changes the course of treatment or the diagnosis,” said Gary Young, director of the Northeastern University Center for Health Policy and Healthcare Research in Boston. He noted that a recent literature search found only about 40 articles or studies on the impact of second opinions. “For the most part, these studies find that second opinions confirm the original diagnosis or treatment regimen,” he said.
Even when a second opinion differs from the first, the result is not always a less expensive course of treatment. “A second opinion could end up costing more money if it leads to a diagnosis or treatment plan that is more resource-intensive,” said Young. However, he noted that a few studies do indicate that second opinions tend to be cost-effective in cases involving treatment for a high-cost condition with significant implications for the patient’s health status.
Overall, there is relatively little evidence that patients who pursued second opinions ended up with a health status and quality of care that was as good or better than what they would have received had they stayed with the original diagnosis or treatment plan, said Young. In the absence of studies, Carew suggested that employers look at their own data on complications and readmission rates among employees who pursued the first or second opinion to determine if second opinions have an impact on costs and outcomes.
As the electronic age and consumerism seep into medicine, they are supporting better use of second opinions, said Thompson. For example, second opinions now rely on more specialized expertise in reviewing medical records and recommended courses of treatment.
As a result, second opinions are identified less as something a health plan mandates and instead becoming another element of consumer advocacy. “Rather than the old managed care approach with health plans second-guessing your provider, the new approach is born in an age of consumerism, where patients are actively involved in their own course of treatment and seeking support from others to help them navigate a health care system that is not always as transparent and engaging as it could be,” said Thompson.
The growing use of electronic medical records makes getting a second opinion much easier and gives patients access to the latest medical knowledge, added Carew. He noted that such an “electronic second opinion” gives patients in certain second- and third-tier geographic markets access to the leading academic medical centers in major markets. By sharing their electronic medical records, “these providers can confirm or modify recommended treatments,” he noted. “Treatment continues to be delivered in the local market, but based on the direction and input of major centers of excellence.”
For instance, employers can contract with services such as
PinacleCare, or the Cleveland Clinic’s
MyConsult Online Medical Second Opinion to provide employees with access to specialists who review their treatment plan based on the patient’s health record, and then share their findings through an online consultation. Second-opinion services do not have a financial incentive to recommend a high-cost procedure if a less-invasive alternative is available, such as working with a chiropractor or physical therapist for chronic back pain before turning to surgery.
Setting Program Guidelines
Because more traditional second opinions—those involving office visits with specialists—are not always necessary and do not always reduce costs or result in better care, it is up to employers to work with their health plans and other benefit advisors to develop parameters to guide their use.
Young suggested that employers develop a decision framework to address when second opinions will be required or recommended. For instance, health benefit managers should consider the implications of a treatment approach in terms of costs and likely health improvement (or possible health risks posed by the treatment). “The less certain the evidence, the more variation there will likely be in recommended treatment approaches, and this may make second opinions more valuable,” said Young.
“Second opinions are not a one-size-fits-all program” Carew pointed out, noting that they are often most effective when used for elective procedures or for conditions with multiple treatment pathways. “What’s most important is to identify the highest-volume and highest-quality practitioners and encourage members to see those physicians,” he said.
Sending the Right Message
Communication about a second opinion program is also critical to its effectiveness. Carew suggested positioning second opinions as an enhancement to the benefits program that does not impose penalties on those who choose not to seek a second opinion.
“A second opinion is more likely to be viewed in a positive light when members understand that in addition to a physician they may have chosen, they also can obtain access to leading experts in the field,” he said. “These are world-class providers, so communications need to emphasize that angle withmessaging that focuses on the advantages to employees in terms of better outcomes and improved quality of life.”
Joanne Sammer is a New Jersey-based business and financial writer.
When Your Boss Doesn’t Trust Your Doctor, MarketWatch, February 2013
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