Researchers have estimated that approximately 30% of U.S. healthcare expenses are related to unnecessary, inappropriate, or wasteful care. During a recent AHIP speaking session titled “The Power of Medical Certainty for Your Members”, Dr. Drew Olivera and Dr. Joel Feigin discussed the role that virtual medical expert consultations can play in curbing unnecessary healthcare spending, and how this can help health insurance providers offer more value and better outcomes for their members.
Dr. Drew Oliveira is the Senior Executive Medical Director for Regence Blue Shield in Washington and oversees the population health programs across the four state Cambia region. For Regence plans, Drew is responsible for the clinical consulting group across the four-state region (executive medical directors, nurses, pharmacists), total population health management of the membership from well-being programs to palliative care and cost stewardship for the health plans at the market level.
Dr. Joel Feigin is the Senior Vice President, Chief Medical Officer of UnitedHealthcare, a division of United healthcare Group that delivers personal health support services to 140 million individuals. Dr. Feigin oversees the clinical strategy development and clinical solution designed for business growth and large employer opportunities. Dr. Feigin joined UnitedHealth group in 2005.
Below are excerpts from the AHIP speaking session, the full recording will be available at a later date.
Do you see health plans and members welcoming a virtual solution for the high-impact conditions that legacy telehealth does not cover in a post-COVID world?
Dr. Drew Oliveira:
We adopted an approach within our states to pay providers the same rate they would get for an in office visit as they could with a telehealth visit. And we did that during the emergency declaration periods within our states. We did that because one, we needed to support our primary care and as well as some specialty practices to continue to provide care for members. We also didn’t want members unnecessarily going into an office setting where they could be at higher risk.
But, what we also are finding is that our members enjoy that process. It’s more convenient for them. They don’t have to leave the house. They can get a number of the services and education and advice through a telehealth approach. I don’t see us wanting to go back to the old way of delivering care. But this new way can actually enhance and actually support a number of our practice initiatives and including primary care practices. So that a primary care doc can now have more of their visits during the day be telehealth allowing more time for in person visits when you actually really need to see someone and spend the time on doing an appropriate level exam.
How do you see a virtual network of experts, specialists being able to meet the demand and enhance the member experience going forward?
Dr. Drew Oliveira:
I think what we learned as we all put the brakes on our entire economy, including the healthcare services, is that there was a forced delay in treatment. And that forced delay allowed people to think, do I need what I’m getting today? Or is there an alternative to that? I think there’s much more concern from our members, in wanting to access the healthcare system. Some of that’s appropriate and some of that’s not appropriate. We don’t want people to delay care.
But that concern and that uncertainty makes it right for having a more virtual network, a network of expert opinions, so that they can develop that certainty. If I do have to enter the healthcare system, I want to go for the right reason to the right provider for the right service. And then they’re going to feel much more confident and trusting of the healthcare system.
Why did you choose 2nd.MD to be your preferred partner for expert medical second opinions? And what factors weighed into your decision?
Dr. Drew Oliveira:
There are multiple different expert opinion programs on the market, we did a review of all of those really to look at what might be needed for our members, but also what might be the best experience. We tend to be very consumer obsessed and we look for partners that are going to also be consumer obsessed.
What we found with 2nd.MD were really three things that stood out to us. First off and probably most importantly is, who are those experts? How can we look at them and easily see that, yes, that would be an expert in that field? And for some carriers, it was less clear about how an expert was chosen. I think the methodology that 2nd.MD used was a good one. I never liked to call an expert, someone who has fewer publications than I do. So that was always nice to see.
The second piece was really the ability for that expert to have a face-to-face meeting with the member. That telemedicine visit with the member was important to us because it really helps that member get the education they need, but also being able to ask the questions and it really goes both ways.
And then the third and probably the other piece of, I think some of this was, the turnaround time. When someone needs an opinion or they’re having an uncertain diagnosis or they need to get going on treatment, they don’t want to wait three, four or five weeks. And having that average three day turnaround time was really important, again, for member satisfaction, but also to make sure that they’re getting the right care in a timely way.
At 2nd.MD, we have seen 85% of consultations either lead to an improved treatment plan or diagnosis. As a result, what are your thoughts on the value of a model that is expert led from the beginning to the end? And what has been the most meaningful impact for your membership?
Dr. Drew Oliveira:
Yeah, It’s really great to have sort of that, I’ll just call it the evidence-based medicine police, for lack of a better term. But when you can get an expert in place, where we’re actually looking at all the most appropriate data specifically for a member to make it personalized for them, and that helps in that whole process. It helps especially when we’re thinking through very complex diagnoses, complex situations or ones where there is a lot more controversy and maybe a lot more preferences that may go into play that may or may not be based in what is the best science for that member. Having that flow makes a lot of sense as we talk about the highly complex, highly controversial types of diagnoses.
Why do you think members are more willing to engage with 2nd.MD? And what do you see as unique within their approach?
Dr. Joel Feigin:
First of all, for UnitedHealthcare, it’s very important to offer a seamless yet integrated solution. And we made sure that we selected a partner who would be flexible and could be integrated within the overall UnitedHealthcare ecosystem and fabric.
Related to engagement, we see this playing out in two very key ways. First, relevant messaging. We built in proactive outreach and targeted communications based on personalized health information and coordinated that with other UnitedHealthcare programs and services. So our member receives information about the availability of second opinions when the information is most relevant to them, and when they’re going to act on it, that teachable moment.
And then second, convenient access. So our nurses, much like your nurses, feel very personally connected with patient outcomes. And therefore, they’re much more likely to make referrals into a trusted, transparent vendor partner, like 2nd.MD. That integrated referral process and feedback loop facilitated by a referral portal, keeps our nurses connected and the members supported with your concierge care.
What demonstrated value have you seen 2nd.MD bring to the large national employers that you serve?
Dr. Joel Feigin:
In our three-year relationship, it’s all about outcomes, clinical patient relevant outcomes. So let me share with you our book of business data, our experience together for 2019. 82% of treatment plans are improved clinically after getting a second opinion. 29% of surgeries we’ve found have been avoided. It was an average cost savings of $5,173. And the service received an overall NPS score of 90.
Can you share some of your experiences on best practices?
Dr. Joel Feigin:
Two come to mind that I would recommend to anybody else considering integrating a second opinion service. The first is leadership support. If you launch with executive support word of mouth, and the example I’ll use is Morgan Stanley, their CHRO, who is a tremendous believer and advocate for second opinions.
We had a case study over a three-year relationship. And that executive support drove their outcomes in large part. We realized together over $6.7 million in total cost savings from consults rendered by 2nd.MD during your partnership for 1.3 to one ROI.
We’ve seen over 7,000 member activations and fully over 2% of the entire population utilize second opinion service, 2nd.MD. Over that three year period, Morgan Stanley members rated our second opinion service with an overall NPS score of 90, just fantastic.
The second best practice that I would encourage for others is that your results can be further improved by deploying communication across multiple channels. In this case, we had a case study with CenturyLink. So we used UnitedHealthcare’s online portal, mobile app, UnitedHealthcare’s customer service and case management referrals, health fairs, proactive outbound calls, internal newsletters, home mailers, and one of my favorites, professional testimonials. And Centurylink positioned this service as a way to give the employees choices that are important to them and the opportunity to better understand treatment and diagnosis through expert consultation. This reduction of procedures saved the company over $3.7 million, a return on investment of 2.9 to one. And that included a 60% reduction in year over year musculoskeletal spend as validated by downstream UHC claims data.
It seems that consumers have more information than ever before. Can you comment on your perspective around the role of shared decision making with an elite level expert?
Dr. Joel Feigin:
So let me contrast two different avenues that individuals can pursue in terms of getting access to information. Individuals are self-guided. Here, patients are exposed to multiple sources of information, but often, this information is incorrect or incomplete. We all know medicine is complex. And even when it’s delivered by an expert, patients aren’t trained to decipher complex clinical information.
So in contrast, using a shared decision making service with a top partner like 2nd.MD, here they’ve made available a dialogue with a trusted, and this is very important, independent expert or panel of experts. I’m also impressed with how you provide adequate time for both education and dialogue. Average consults run between 30 and 45 minutes. And then your guidance is aligned with patient preferences and you even offer the ability to involve patient family members and caregivers into their treatment decisions, which is critically important.
So, where’s the value in shared decision making with 2nd.MD? What we found time and again, is when a patient is familiar with their own condition and its related health impacts. They become meaningfully engaged in their care pathway. And what we find is adherence to 2nd.MD expert opinion recommendations is 96%.