How virtual second opinions uncover cost savings for common employee conditions

Rising healthcare costs are a fact of life for most companies and their employees. As of 2020, the average annual insurance premiums for employer-sponsored family health coverage totaled more than $21,342. Even factoring in the average contributions by employees, the costs shouldered by companies still reached $15,754. Those figures, moreover, were more than 72% higher for employee contributions and 65% higher for employer contributions than they were in 2010.

Chances are you already negotiate with your broker, raise deductibles or leverage other strategies to maintain reasonable premiums. But there's another option you may not have considered to reduce costs throughout the year: Offering access to a virtual second opinion (VSO) program for employees faced with life-altering or chronic diagnoses like heart disease, musculoskeletal (MSK) conditions, cancer and others. 

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Not only will you show employees that you are looking out for their best interests, but a VSO program can significantly reduce the risks and costs associated with misdiagnoses⁠ — the leading cause of incorrect treatment and unnecessary healthcare expenses to companies and their employees. 

The Cost of misdiagnoses
Indeed, misdiagnoses are costly in an already expensive healthcare system. Consider the following statistics:

• Two of every three treatment plans for complex medical conditions must be significantly modified due to incorrect diagnosis, according to one study.
• One of every 10 patients with cancer or a cardiovascular condition initially receives an incorrect diagnosis, according to the same study. 
• Misdiagnoses in breast cancer cost employers $4 billion a year.
• An estimated $65 million in avoidable expenses for every 100,000 employees and health plan members result from misdiagnoses. 

Errors like these add substantially to the high costs of healthcare, especially for cardiovascular disease, musculoskeletal conditions and cancer — three of the most common employee health conditions. By 2035, cardiovascular disease is projected to cost $1 trillion a year, including expenses associated with doctor visits, sick leave, and short- and long-term disability. The costs of treatment for musculoskeletal conditions rose from $10 billion to $20 billion between 2010 and 2019. Healthcare spending for breast cancer treatment is expected to reach $246 billion by 2030, up by more than 30% since 2015. The average cost of prostate cancer treatment, meanwhile, ranges from $28,000 for patients in the early stages to $100,000 for those in more advanced stages.  

Read more: High healthcare costs are pushing employees to put procedures on hold 

An expert second opinion program can help alleviate the financial pain for employers by ensuring that employee treatment is as effective and medically necessary as possible. For instance, one recent report has found that every dollar invested in a second opinion program can reduce medical costs to employers by $2.63. 

The benefits of VSOs: 3 use cases
Three use cases from our experience illustrate the usefulness of VSOs for these common health conditions: 

1. A patient with a previous history of myocardial infarction sought a VSO after his cardiologist recommended catheterization to evaluate his heart and blood vessels. Upon reviewing the patient's records, a specialist found no reason for the invasive procedure. Instead, he recommended basic lifestyle modifications and a slight change in the patient's medication regimen. The new treatment plan saved $40,000 in treatment costs.  

1. A patient sought a VSO after his orthopedic surgeon diagnosed the pain in his shoulder as a torn rotator cuff and recommended surgical repair. After reviewing the patient's MRI exams and other records, the specialist believed that the partial thickness tear required only home-based physical therapy. As a result, the patient avoided significant surgery, significant additional pain, and lost productivity from time away from work.   

1. A Florida patient received an initial diagnosis of ductal carcinoma in situ, a form of breast cancer that is generally confined to the superficial layers of the breast and has a good prognosis. The patient sought a VSO, during which a pathologist believed the specimens represented infiltrative breast cancer, a more severe form requiring more aggressive treatment. Although this VSO resulted in a more expensive treatment plan at the time, the more accurate diagnosis likely prevented many thousands of dollars from being wasted on treatment that ultimately would not have worked and may have caused the cancer to return or be undertreated leading to reduced life expectancy. 

According to an informal survey conducted as part of a presentation at the most recent Society for Human Resource Management meeting, only 16% of the attendees reported offering VSOs to their employees. Given the benefits of second opinions, more organizations would do well to offer access to VSO programs not just as a unique and necessary benefit, but also as a way to save costs for both their employees and their organization. 

Choosing medical treatment requires expert help
Ultimately, the stakes are high in healthcare, where selecting the right treatment hangs on getting the right diagnosis. Offering your employees the option of a virtual second opinion from a world-class organization ensures they get the right care at the right price⁠ — for them and your organization.