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With employers looking for ways to provide top benefits while watching costs, there's a growth in telehealth and remote second opinion services. Massachusetts General Hospital has been offering both since 2014, serving more than 10,000 patients. Sarah Sossong, the hospital's telehealth director, and Tony James, its senior vice president of network development and integration, discussed the trend toward telemedicine, its benefits and its future with Business Insurance Editorial Assistant Joyce Famakinwa. Edited excerpts follow.
Q: How did Massachusetts General Hospital get into offering second opinion services?
Mr. James: We do second opinions every day, but what we realized is we didn't have a concerted approach to it. And so ... probably two years ago, we started thinking about how do we do this and what we needed to organize our physicians and which vendors we should work with.
Ms. Sossong: Mass General clinical experts provide the second opinion, but there are a lot of other elements involved in the second opinion process, including record collection and correspondence with the patient. Mass General began providing second opinions for patients referred by Grand Rounds (Inc.) in October 2014, and as of April of 2016, Mass General launched our own second opinion website through which an individual consumer may now request a second opinion directly from Mass General.
Q: How well-received has it been among employers?
Mr. James: We're working through a partner (Grand Rounds) — it's been extremely well-received … The number of second opinions we have rendered even outstretched that high end of our potential estimate.
Ms. Sossong: I think many, many employers have this as a benefit service for their employees, and I think they see a lot of benefit. I would have to double-check on the exact numbers, but it's something like in 60% of cases, there is a change in diagnosis or a significant change in the treatment plan, and the hope is that ends up being something that is better for the patient and the employer in terms of cost, quality and outcomes.
Q: For what conditions are the services most useful?
Ms. Sossong: I think the specialties where we're seeing the highest volume … are in cancer, neurology and stroke, orthopedics, cardiology, (gastrointestinal), pediatrics … Those are the things where they're really suited to second opinions.
Q: What are benefits for employers and employees?
Mr. James: Changed diagnoses are probably the biggest one. So if ... you have a type of cancer and they think it's going to be treatment A and, after you talk to folks here who deal with this more, doing more cutting-edge research ... and it really is perhaps B or C that would be better for you, that is huge, to get you to the best treatment. From an employer's perspective it is if that second opinion can save you from not going down the path that would be not as helpful to the patient and also, then, if you needed to go down B but you went down A and then you had to go down B later, you not only lost time, which may be detrimental to a patient, but you've also increased the cost to the employer and to the patient.
Q: What do you see as the future for the services?
Ms. Sossong: Hopefully we can incorporate second opinions into a flow of care that would include other services. So, for example, if you have a second opinion and say you need to come to MGH for care — say you live on Martha's Vineyard, so you come to MGH for your care — then you go back to Martha's Vineyard after your in-person care.
But then we could incorporate these virtual visits and other modalities so that they would all blend together in a way that really takes the best care of the patient in the place that they're at.
Right now we're doing this as a direct-to-patient service. We're hoping that we'll be able to expand the ways in which we're offering this, and I think this is probably a little ways off, but there's a lot of interest at MGH in global health and community health, and there may be a point where we can also be offering this to people who could never afford to pay for it.
On the flip side, there may be ways in which this can benefit the educational system. MGH is an academic teaching institution and, for example, there are conditions that are very common in China or South America that we just never actually see in Massachusetts. So at the same time that us providing second opinions can be very helpful to remote patients, it can also be something that could be potentially also a good teaching experience for us.
Q: In what ways have these services been cost-effective for patients?
Mr. James: If you lived in Iowa, and you needed a second opinion, you don't have to drive or fly to wherever — both the costs of travel, the cost of leaving work for both you and whatever caregiver is going with — that's a direct cost. The second is … not going down treatment paths which aren't going to be as helpful, which, too, are then both costs to the patient and to their employer in the system as a whole.
Q: What are some of the reasons for misdiagnoses?
Mr. James: I think there are a number of reasons. Just think about if you have a very rare form of some kind of disease ... and you're in a community that does not have a deep bench of specialists who see all the permutations of that disease on a frequent basis. They're just not going to be as familiar with it and not be as familiar with what to do with it...Oncology's a great example. There are so many different types of mutations that occur and so many more treatments that are being brought online every day at academic medical centers, like MGH and other places around the country, that if you're a community oncologist and you see a lot of breast and lung cancer, but you don't see much liver cancer or you don't see much rectal cancer, you may not know the best new way of treating those things. So your diagnosis, while it may be correct … you may not know what else you should do, or the best new thing to do that has come out in the last month.