Blog | Innovation and Disruption

Cleveland Clinic strikes deal to provide virtual second opinions to Aetna members

Blog | Innovation and Disruption

Cleveland Clinic strikes deal to provide virtual second opinions to Aetna members

  • The Cleveland Clinic and Aetna, as part of a nationwide initiative, will offer Aetna commercial plan members access to virtual second-opinion services from Cleveland Clinic providers, according to a Healthcare Dive article.
  • They are also creating a Cardiac Center of Excellence program for plan sponsors nationwide, the article said.
  • Last year, Cleveland Clinic announced a nationwide partnership with American Well to provide telehealth services, according to HFMA’s Chad Mulvany.

Healthcare Dive is reporting that the Cleveland Clinic and Aetna, as part of a nationwide “initiative will offer Aetna commercial plan members access to virtual second-opinion services from Cleveland Clinic providers. They are also creating a Cardiac Center of Excellence program for plan sponsors nationwide."

Takeaway

That development didn’t take long. Last year, Cleveland Clinic announced a nationwide partnership with American Well to provide telehealth services. Center of excellence (COE) models, similar to those the Cleveland Clinic partners with, select employers that have proved their ability to reduce the total cost of care and improve outcomes.

A 2017 Harvard Business Review article reports: “While nearly all of the 450 spine patients who presented to one of the participating centers had been recommended for surgery by providers in their home markets, only 62% of the patients were found to be suitable candidates for surgery by the COE sites. Instead of unnecessary surgery, activity-based therapies, pain injections, physical therapy, or weight loss were recommended by our providers.” Most of the savings for the employer comes from the second opinion.

And for Cleveland Clinic, even if the patient ultimately didn’t have surgery at the Cleveland Clinic, the model generated increased revenue by increasing the volume of specialist services provided to patients in markets where it doesn’t have a physical presence. However, the rate-limiting step on the physical model was the number of employers willing to ship their patients off to Cleveland for a second opinion. This constrained the volume of patients due to both the number of employers who had a large enough population to participate and the types of procedures where the economics were such that it made it worth it to have an employee travel to a COE site in another city.

However, when you take this model virtually and offer it to a large national payer for all of their employer accounts, the revenue opportunity for providing specialist services to patients in markets distant from the Cleveland Clinic increases significantly. This helps Cleveland Clinic achieve its goal of having 50% of its outpatient visits delivered virtually. And for providers in local markets, the potential for demand destruction increases significantly as the number of employees covered and diagnoses expands.

Further, beyond reducing the volume of procedures performed at local hospitals via more conservative management, this may also re-route volume. The Cleveland Clinic has partnered with a number of hospitals across the country to develop affiliated institutes, which could impact referral volume in select markets. So, for example, if a patient in the metro D.C. area has a cardiac issue that actually requires an elective procedure, it’s likely the Cleveland Clinic cardiologist providing the virtual second opinion will refer the patient to a cardiothoracic surgery at Medstar Washington Hospital Center, which has partnered with the Cleveland Clinic on an affiliated institute.

About the Author

Chad Mulvany, FHFMA,

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

Advertisements

Related Articles | Innovation and Disruption

Blog | Innovation and Disruption

Aetna rolls out a no-cost sharing primary care offering for members at CVS Minute Clinics and HealthHUBS

HFMA's Chad Mulvany says it’s not surprising that Aetna would use its Minute Clinics as the basis of a primary care network for lower-cost health plans.

Blog | Innovation and Disruption

Why Walmart is partnering with Oak Street on three in-store clinics in the Dallas-Fort Worth area

HFMA's Chad Mulvany says Walmart's partnership with Oak Street is due to Oak Street’s reputation for developing a patient-centric care model.

Blog | Contracting

Business Group on Health's Annual Survey: Large employers ready to take the reins on healthcare cost

Responses to the Business Group on Health's annual survey of its large employer members suggest employers are tired of waiting for providers and plans to figure out how to reduce healthcare cost.

Column | Innovation and Disruption

Biohacking: What healthcare finance leaders need to know about this evolving enterprise

Biohacking is an emerging concept in healthcare that may have value in enabling healthcare providers to better manage the costs of care.