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Cheat Sheet

Remote Second Opinion programs are growing. Here's what you need to know.

15 Minute Read

    Key Takeaways

    • Remote second opinions (RSO) allow specialists to review and consult on complex patients’ cases without an in-person interaction.
    • RSO programs benefit multiple health care stakeholders. Patients get access to specialists, local providers gain insight about how to care for their patients, specialists and their health systems increase their revenue through remote consults and downstream volumes, and health plans and employers limit unnecessary utilization.
    • Effective programs require cross-stakeholder buy-in to generate internal support and external demand. Typically, innovation or strategy teams drive the initiative, existing physicians perform the expert consultation, and marketing launches campaigns to garner interest.
    • Covid-19 highlights telehealth’s value to treat patients in different ways. RSOs are a subset of telehealth that empowers patients to seek the right care from the most appropriate specialists.



    What is it?

    RSOs allow patients and existing providers to access specialist consults for complex cases without the need for in-person encounters. Patients or referring providers request an RSO and a specialist or subspecialist reviews the case and either confirms a diagnosis and proposed course of treatment, or recommends further testing or new treatment plans based on specialty expertise.

    The most common populations who use RSOs include patients with complex or life-threatening conditions and patients in rural areas.

    Use this infographic to understand how to teach providers the ways your product fits into the full patient journey.

    RSO companies offer a variety of service models to facilitate specialist opinions. Service companies rely on administrative staff to procure all relevant documents and pass these to specialists, while software companies optimize technology to streamline labor-intensive document consolidation. Both service and software companies transfer patient records and clinical information to the specialist for review.

    remote second opinion spectrum


    Why does it matter?

    Access to specialty care is limited in large parts of the United States. Many patients who opt for an RSO lack specialists in their immediate geographic area. There are 30 specialists per 100,000 people in rural America, compared to 263 in urban areas. However, RSOs apply to all patient scenarios—including in urban areas where patients or providers seek expert consultations for complex, or rare diagnoses from the most appropriate specialist.

    Ready-to-use slides: 5 things health tech vendors need to know about physicians

    distribution of U.S. specialists

    This disparity is particularly true in oncology, where only 7% of all oncologists practice in rural areas. A 2019 Advisory Board survey of cancer patients showed the most important feature when deciding where to seek cancer care is “a doctor who specializes in my care.”

    oncologist statistics

    Some data suggests that RSOs may result in changes in more than 80% of initial diagnoses. However, more conservative estimates indicate that an RSO can affect initial diagnoses or care plans in 20-40% of cases. RSO consults broadly impact not only patients, but other important health care stakeholders.

    stakeholder benefits


    How does it work?

     RSOs consist of five main stakeholders: patient, local provider, specialist (sometimes referred to as the ‘expert’), payer or employer, and RSO company. Providers may launch their own program, or can partner with RSO companies to use their software and services to streamline the end-to-end process.

    Here are five questions we are sharing with providers to help them determine the value of an AI vendor’s product.

    The RSO workstream requires a patient or local provider to initiate a case. Then, a provider—with or without an RSO company—compiles all relevant documentation (e.g., imaging files, labs, pathology records). This is typically the most time-consuming part of the process. After compilation, an assigned specialist reviews the records and the initial clinical question(s). The specialist bills the patient for his/her services and delivers the remote second opinion typically within two weeks of receiving all the files.

    RSO timeline


    What are the challenges?

     While RSOs help patients connect to appropriate specialists around the country, launching an effective program requires clinical and administrative leaders to overcome four main barriers. These barriers include clinician education, organizational buy-in, workflow integration, and reimbursement. Any provider organization should proactively address these challenges when starting an RSO program.

    barriers to success


    Remote second opinions in practice 

     RSOs can result in diagnosis confirmations, adjustments, or care plan changes. A confirmed diagnosis brings peace of mind to patients and local providers, while the latter two bring clarity and confidence to the patient and local provider.

    diagnosis and care plan example

    Conversations you should be having
    1. Current mechanisms to efficiently address rare, complex cases
      and second opinion consults 

    2. Strategies for leveraging specialists to increase in-market and
      out-of-market penetration and direct-to-consumer demand

    3. Specialists’ buy-in to perform remote second opinions without
      exacerbating burnout

    4. Resources needed to support RSO program investment

    5. Covid-19 impact on demand for remote consultations for highly
      complex, or rare patient cases 

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