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Second opinions fan out for improved results


As employers seek ways to save money on medical costs, many are enlisting the second opinions of medical experts nationwide, a relatively new tactic that experts say can lead to immediate savings.

Offering employees the option of a second opinion when it comes to complicated and rare conditions, in addition to everyday health care issues, can save employees from diagnostic errors, unnecessary procedures and more, experts say.

“Everybody agrees that there is a lot of money spent on health care, but there is a lot of money spent on unnecessary procedures,” said Ed Lehman, Los Angeles-based senior vice president for national accounts client management and channel partnerships at Grand Rounds Inc., which provides a range of second-opinion services for employers. “Second opinions ensure that employees and their families, as patients, get the right care as quickly as possible and as early as possible.”

The Washington-based National Business Group on Health estimates that 60% of employers are offering this service through a variety of vendors. Aon Hewitt found that 58% of 804 employers surveyed plan on adding the service in the next five years, said Jason Mahler, Houston-based senior vice president of health and benefits for Aon Hewitt.

Typically, the service is tacked on to an employer's benefits offerings and experts say it can cost between $1.50 to $8 per enrollee per month, depending on the level of service. To date, there is no hard data on how much this can save.

“I think it's on the rise because employers are interested in anything that will help rein in costs and produce greater outcomes,” said Mr. Mahler. “Oftentimes these programs pay for themselves.”

Dr. Ronald S. Leopold, Atlanta-based chief medical officer with Lockton Cos. L.L.C., said he likes to steer clients to second-opinion services to ease confusion and reduce the need for often costly procedures and treatments.

“This is a service where a member can call up an expert, independent of their carrier and carrier's network, and have somebody work with them, collect all their medical information, have their information and maybe have a new opinion,” said Dr. Leopold.

The service works best for patients with high-cost, high-risk conditions, people with multiple diagnoses and those diagnosed with conditions that have a high level of uncertainty, he said. Shari Davidson, Washington-based vice president of health care costs and delivery for the NBGH, puts it much more broadly: “Anything that has somebody scared.”

Mr. Mahler recalls an incident where a client's employee had been sick for five years, and it took a second-opinion service to diagnose and successfully treat the employee for a rare form of blood cancer. “You get these stories where things are undiagnosed and unsolved for years,” he said.

According to data from Grand Rounds, 16% of the time a second opinion changes a diagnosis and 50 % of the time the treatment for a correct diagnosis is altered in the best interest of the patient. “Two-thirds of the time we make a change,” said Mr. Lehman.

Aamir Rehman, Chicago-based partner and head of clinical service for Mercer L.L.C.'s total health management group for North America, says the trend for second-opinion health services has more to do with quality of care than return on investment.

He highlighted musculoskeletal and spinal issues as areas where a second opinion can make the difference between an unnecessary and painful experience and one that leads to a better, less invasive outcome. “Something like a back surgery would be a flag to get a second opinion involved,” he said.

Ms. Davidson said medical decisions are often based on who is standing in front of you: “If you talk to a surgeon, they'll say surgery; if you talk to a physical therapist, they'll say physical therapy.”

“Health care is very complicated and employees don't always know the right way to go,” she added. Second-opinion services “put them in touch with the best doctors so an employee can fully understand the range of possibilities.”

Many of these programs are run through “centers of excellence” around the country, which can put patients in touch with the experts in the field they need, Ms. Davidson said. A center of excellence is a facility that provides leadership, best practices, research, support and training for a specific area of medicine.

Grand Rounds maintains a database of 2,000 medical experts in various fields nationwide, according to Mr. Lehman. Much of the time the second-opinion service is provided remotely via telephone, with an expert gaining access to a patient's records to make a decision, he said, adding that in-person visits with physician-experts is another service that is on the rise.

“These are leaders in the field that employees can have access to,” he said.

While the service is promising — the NBGH says 60% of companies offer it — the utilization rate remains low, according to Ms. Davidson.

“We know sometimes employees don't use (second-opinion services),” she said. “In focus groups, we hear that oftentimes they forget they have access to it.”

Ms. Davidson said companies that sign on need to better inform employees that the service is available. Incentives are another way to increase participation, she said.

Dr. Leopold agreed that utilization is low and that companies can better help their employees by providing information about the program regularly.

“(Companies) can also use pharmacy and medical claims data to reach those employees who may not know about the service,” he said.