Comprehensive sets of data and leading-edge technologies coupled with established guidelines and protocols are foundational components of today’s health care system. Increasingly, diagnosing, determining procedural pathways, and performing specified procedures can be performed with little to no human intervention. But in most cases, and particularly with complex medical conditions, diagnosing an individual’s condition and deciding the best course of treatment to pursue ultimately fall back on human understanding and decision making. And not all medical professionals have access to the data, technologies, and supporting information needed accurately diagnose and treat all conditions. And humans have biases and can make mistakes – particularly in today’s busy, overloaded medical practices.
Health plan and employer support for individuals seeking to confirm their diagnosis via a second opinion are particularly important as consumers and employers look for ways to manage spending and drive the demand for value.
Second Webinar in a Series of Three HCEG Webinar Series Events in October 2021
In Using Virtual 2nd Opinions to Increase Member Engagement and Decrease Healthcare Costs presented on October 14th, HCEG’s Ferris Taylor joined Dr. Rodney Musselman, MD, and Bob O’Brien of Medical Review Institute of America (MRIoA), to discuss how second opinions provide additional value and benefits to plan members and employees. This post shares highlights of this second webinar in a series of three webinars held during October on Care Management.
Watch the webinar here
Virtual Second Opinion: Addressing Healthcare Industry Pain Points
Bob O’Brien, an executive in MRIoA’s Best Care Business Unit, shared an overview of the pain points and specific diagnostic areas that are driving plan members to seek a second opinion – often a virtual second opinion. These pain points include:
- Accelerated prescription drug spending
- Lack of data analytics
- Lack of access to MD specialists
- Inefficient turnaround time
- Lack of purposeful reviews
Watch here as MRIoA’s Bob O’Brien shares more on pain points, diagnostic areas driving the use of a virtual second opinion, and various statistics supporting the use of virtual second opinions.
Patient Education & Alternative Treatment Options: Key Elements of a Virtual Second Opinion Program
- Patient Report – shares information to the member/patient on what care alternatives are available.
- Clinical Report – provides PCP or specialist with information on why care alternatives are being offered
- Educational Video – provides an overview of the original treatment for which the patient/member sought a virtual second opinion including recovery process, risks, costs, and treatment alternatives.
Watch here as Bob shares an overview of the patient education, alternative treatment options, and other unique aspects of MRIoA’s virtual second opinion platform. And contact [email protected] to receive a sample Patient Education Video.
Combining a Virtual Second Opinion with Prior Authorization Requirements
It was noted that a prior authorization that’s approved for a specific procedure is not an indication that the proposed surgery is the patient’s next best health care choice. Accordingly, offering a complimentary virtual second opinion in lieu of a prior authorization could be a better way to provide care and cut down on overutilized services. Alternatively, a second opinion can also be used in conjunction with an existing or enhanced prior authorization program.
MRIoA’s Bob O’Brien emphasized that supporting a second opinion program isn’t about restricting any access to care but rather really about helping ensure that the best and most appropriate care is being presented to the patient.
Watch here as Bob O’Brien shares potential cost savings and an overview of a combined prior authorization/virtual second opinion program.
Addressing the Strain of High-Cost Specialty Drugs – Independent Clinical Review
As has been shared often in HCEG webinars, roundtables, and other presentations, the use and cost of specialty drugs have been rising rapidly with no end in sight. Dr. Rodney Musselman, MD, Executive Medical Director at MRIoA, noted that for 85% of employers, pharmacy pricing was their predominant concern going into 2020.
Dr. Musselman described how MRIoA has created a solution that utilizes national experts to provide insight into the overall management of patients that have rare or complex disease states. These experts validate when specialty drug treatments are appropriate; including the site of care, where drugs are being delivered, and provide options appropriate to consider for a specific patient. These experts then consult with patient care providers to help develop the best course of treatment.
Virtual Second Opinion Program: Deliver Immediate Cost Savings to Health Plans and Employers
- Deliver immediate savings that save money at the next renewal, not two or three years down the road.
- Continually communicate with member population to make sure are aware of second opinion benefit.
- Educational video
- High-cost medications review process backed up by 30+ medical directors and 20+ pharmacists
Watch here as Bob O’Brien shares details on how MRIoA’s programs deliver immediate costs savings.
Learn More About MRIoA’s Virtual Second Opinion and Other Programs
We appreciate the information shared in this webinar by Bob O’Brien and Dr. Rodney Musselman, MD of the Medical Review Institute of America. Review this animated video that illustrates MyCareChoices workflow process to provide patients/members with 2nd opinions and virtual access to prominent MD specialists.
Connect With, Learn From, and Share with Other Healthcare Leaders and Professionals
If you’re an executive/leader of a health plan, health system, or healthcare provider organization, consider joining one or more of our Focus Area Roundtables. These 45-minute, small group discussions address a specific priority of the 2021 HCEG Top 10+ and provide all participants a chance to share and ask questions of other participants. We currently have a number of roundtables scheduled with additional roundtables being planned.