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Healthcare benefits: Why offering individuals the option of a medical second opinion ensures peace of mind for all

 

Illness is frightening. Diagnosis is frightening. But what happens if the diagnosis is wrong or the treatment suggested isn’t the most effective option?

Unfortunately this happens more often than most of us realise. That’s why adding a second medical opinion programme to your critical illness or health insurance benefits package can provide the reassurance badly needed by those diagnosed with a serious condition.

It also provides an effective way that you as a benefit provider can enhance your health offering to your enrollees without adding high cost. This is the route currently taken by 23% of employers in the US, with a further 8% planning to do so soon, according to a recent survey by a global management consultancy. Meanwhile, 27% said they were considering using second medical opinion programmes at some point in the future.

These companies understand the value placed by individuals on benefits such as healthcare. A 2015 Employment Confidence Survey by recruiting site Glassdoor revealed that four in five respondents would prefer an increase in benefits to a pay rise, with healthcare topping the priorities list.

A 2015 Employment Confidence Survey by
recruiting site Glassdoor revealed that four in
five respondents would prefer an increase in
benefits to a pay rise, with healthcare topping
he priorities list.

An added advantage is that well-managed second opinion programmes can help control healthcare costs by making sure your enrollees enjoy swift access to the best and most appropriate treatment.

How widespread are misdiagnoses? 

While your policies may offer a range of pre-screening tests, there’s always the chance that an enrollee will develop a critical illness such as cancer or heart disease. It goes without saying that when an insured person develops a serious condition, it’s natural to want to do everything within your power to help. Illness also has a serious impact on productivity as it relates to employee benefits.

So is your company doing enough?

Misdiagnosis is a major problem. According to Mark Graber, founder of the US-based Society to Improve Diagnosis in Medicine, there are around 10,000 diseases, but the average primary care doctor sees only 300 or 400 a year. It can be challenging for doctors to get it right in every circumstance.

In 2014, research in the British Medical Journal revealed that in the US around one in 20 people per year – that’s around 12 million – receive an inaccurate medical diagnosis, with half of these thought to be potentially harmful. Even more worryingly, 2009 research in the Journal of the American Medical Association estimated that between 40,000 and 80,000 deaths occur every year in US hospitals due to misdiagnoses.

Several studies show that in Indonesia, people with lung cancer are at increased risk of a misdiagnosis because of the prevalence of tuberculosis, as symptoms of both diseases are similar.

Meanwhile, a 2016 UK study published in the European Heart Journal found that nearly one third of all heart attack patients had an initial diagnosis that was different from their final diagnosis.

Differences of opinion

But it isn’t just a question of mistakes. Doctors may have different opinions that stem from where they trained, the technology available and their professional experience.

A good example comes from South Korea, where researchers investigated the causes of chronic cough – a common ailment. The 2016 study in the journal Medicine found that some conditions were more likely than others to be the cause – chronic obstructive pulmonary disease rather than the reflux disorder, GERD, for example. This was contrary to previous findings. However, limited access to up-to-date research could mean that doctors are at risk of focusing on the less common causes, to the potential detriment of the patient.

Some doctors may take a more passive approach, preferring to monitor a condition or recommend less aggressive treatments, while others may opt for treatment straight away. The patient, though, is unlikely to know how decisions have been reached, and simply wants to get the best advice and treatment.

Giving members a choice

Alongside that natural need for confidence in the medical profession comes the gradual drip-feed of media stories about misdiagnoses and the side effects of treatment. The result is extra anxiety for the patient at a time when all they want to do is to be able to trust their consultant.

No company should ignore the fact that many people simply have to accept whichever doctor they can get access to. In Indonesia and Myanmar, the World Health Organization (WHO) reports that there is only one physician for every 1,000 people – half the number in Singapore.

No company should ignore the fact that many
people simply have to accept whichever doctor
they can get access to.

Demographic changes, including more urban lifestyles and an ageing population, have led to a rise in chronic diseases, which account for around 70% of the disease burden in Southeast Asia. And greater incidence of chronic disease means even more pressure on healthcare services.

It’s little wonder that many people are frustrated with their limited treatment options and access to specialised care. The need for more than their doctor can give them is one of the reasons so many people head straight to the internet – in Europe, half of patients go online after receiving a diagnosis to look for other treatment options.

Rather than abandoning your members to the potentially dubious advice of the internet, offering them access to a second medical opinion will give them a real chance of a better outcome. And for employers that means employees may be back at their desks more quickly.

A second opinion service that works

Medical second opinion is a value-added service, so the first step is to look at your benefits package in detail. Put yourself in the shoes of a newly diagnosed member and check whether what’s being offered gives access to specialists and a route to the best outcome.

The next step is to contact your healthcare benefits provider. Ideally, you’re looking for a service that will work equally well, whatever the condition and wherever the member. In some cases, the company picks up the bill and the service is entirely free for members. In others, the service is subsidised by the member’s employer.

Most services offer face-to-face consultations, and you’ll need to decide on options for covering travel and accommodation expenses. Others are virtual, using phone or web-based communication so that there’s no need for a member to travel. The best, of course, will offer both.

 

However, perhaps the most important question to ask is, who will be providing the second opinion – a recognised centre of excellence, a network of specialists, or both? You and your healthcare provider will also want to decide on what diseases are covered by the plan. In many cases, this includes major conditions such as cancer, heart disease, stroke and kidney failure.

The benefit will be of no value to your members or employees if the system is difficult or time-consuming. Ideally, you would aim for the member/employee and their doctor to receive a written review of the original diagnosis and a proposed treatment plan from the selected medical centre within ten days. So, at the planning and decision stage, it’s important to fully understand the process for getting a second opinion.

Members should have a single number to call and be able to start the process straight away. From there, the service needs to get the patient’s consent to release their details, so their doctor can prepare the relevant records. Choice is key – so the provider should offer a list of medical centres for the patient and their doctor to choose from.

Back in 2015, the Texas A&M University System added a free second opinion service. Within 40 days of the scheme being launched, 58 employees were using the service. Thirty-seven of them believed it had improved their understanding of their condition and how to deal with it, and a further ten were referred to a specialist. By having consultations outside work hours, the service also saved 21 working days. 

Communication is key

But even when a second opinion service is free, many members still don’t take advantage of it because they feel they’re being disloyal to the doctor who originally diagnosed them. Patients need ‘permission’ to get a second opinion, and that’s where effective member communication is vital.

But even when a second opinion service is free,
many members still don’t take advantage of it
because they feel they’re being disloyal to the
doctor who originally diagnosed them.

In 2013, a survey of employee benefits in Thailand by a global management consultancy revealed that one third of Thai companies didn’t actively communicate benefits to their employees. The result was, of course, poor understanding of those benefits. The two-thirds of companies that got it right used a mix of email, online benefit portals and total reward statements to get the message out to their people. 

At Texas A&M, the HR department launched the scheme with a press conference at which an employee from a different organisation shared his experience of getting a second opinion. Employees were sent an individual letter and an email announcement, and received a membership card through the post. There was also an article in the internal newsletter. Over time, the benefits of the service become reinforced by sharing success stories. The message is a simple one – here’s a service that can give you confidence in your medical decisions.

Benefits that could pay for themselves

Given the competition for talented staff and the cost of re-hiring when employees leave, a generous benefits package is essential for any business. It gives employees reassurance and could potentially change not just their care plan but their lives. For the company, it’s a low-cost route to a healthier workforce.

For insurers, this programme helps align members with the best treatment plan and medical provider for their diagnosis or condition. The aim is to improve medical outcomes, often leading to fewer complications and lower claims costs.

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Inova care is an industry leading consulting and health care administration company specializing in managed care, clinical pathways and cost containment solutions for corporations and insurance companies.

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