The Clinic by Cleveland Clinic sees strong first steps with virtual second opinions

Peter Rasmussen sees a growing interest in second opinions.

Peter Rasmussen, chief clinical officer of The Clinic by Cleveland Clinic (Photo: Cleveland Clinic)

Rasmussen is the chief clinical officer of The Clinic by Cleveland Clinic, a partnership between the Cleveland Clinic and Amwell, the telehealth company. The Clinic by Cleveland Clinic allows patients to get second opinions virtually for a diagnosis of cancer, heart disease or other serious conditions.

“That's been a very good, thriving program for us,” Rasmussen tells Chief Healthcare Executive®.

The virtual second opinion program has been growing about 75% annually, he says. Typically, the program is seeing 275-300 patients a month.

While the primary focus is on virtual second opinions, the Clinic is going to be moving into virtual management of chronic diseases, he says.

In a recent interview, Rasmussen talks about the Clinic’s success in virtual second opinions, the Clinic’s plans to expand its services, and how health systems can do more with telehealth.

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‘Hope and alternate options’

Other competitors are offering second opinions via telehealth, but the Clinic touts its world-class physicians as a key differentiator in the market. Rasmussen extols the value of expanding access to top physicians via telehealth.

“People otherwise would either not be able to get an opinion from a Cleveland Clinic physician, or have to go through the travel and the hassle of going from, wherever they are to come to Cleveland to get that opinion,” he says.

About 25% to 30% of the time, the Clinic is finding a different diagnosis than the local provider, Rasmussen says.

About three-quarters of the time, physicians from the Cleveland Clinic will make at least some alteration to the treatment plan, Rasmussen says. Those changes could include additional chemotherapy drugs or recommending surgery when it wasn’t indicated.

More than 90% of the time, patients follow the recommendations of The Clinic, he says.

In some cases, Cleveland Clinic physicians are finding that cancers may be at a more advanced stage than the initial diagnosis.

“And that obviously has great impact to the patient because if the cancer’s not properly staged, they may be undertreated, which would increase their risk for recurrent disease or not treating metastatic disease that may be present,” Rasmussen says. “Under-diagnosis is a significant problem in cancer.”

The Clinic’s doctors will also be able to perform surgery in cases where doctors initially said it wasn’t an option for some patients.

“In cardiac care, for example, they may be told they have no further options for their heart failure,” Rasmussen says. “We may have options to offer for them. They might be told they're not a surgical candidate for something like a heart valve problem. Of course, we've had great experience with valve surgery at Cleveland Clinic, and a lot of types of things that are not operative at one hospital are sort of routine for us. So we're able to offer those patients hope and alternate options.”

Rasmussen cited a case involving a young woman from Brazil who had congenital aortic stenosis and was initially told by local doctors that there was no surgical option.

“Our surgeons looked at it, and they're just like, ‘This is just a routine case,’” Rasmussen recalls. “And she came up a month later and had her surgery.”

The woman is now back in Brazil, and she’s in medical school, he says.

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Virtual monitoring

The Clinic has been partnering with payers, and is also building more deals with employers to offer its second opinion services.

Going forward, The Clinic is going to be expanding its services and offer more remote management of serious illnesses, Rasmussen says. He calls it a “logical extension.”

“I think generally speaking with a lot of chronic diseases, they're amenable to technological augmentation,” he says.

Hypertension is one example of a disease that could be managed virtually, he says. Many patients can get medication through virtual means, he says.

“It's not clear to me why a chronic disease that has such an impact on heart disease and stroke in this country, isn't better managed with the simple technology tools,” he says.

Expanding access

Many health systems and hospitals have expanded their telehealth programs due to the COVID-19 pandemic, and Rasmussen says video and telephone visits are important in expanding access. But he says health systems can expand their offerings.

“I think health systems that want to stay committed to a digital change for their patients, they ought to be adding connected devices to the mix,” Rasmussen says. Incorporating simple devices such as blood pressure cuffs or EKG monitoring can augment telehealth services.

Beyond that, Rasmussen says health systems should think about ways to expand their geographic reach, particularly in rural areas. He envisions “diagnostic outposts” in places such as strip malls where health systems can offer services such as medical imaging and X-rays “so patients don’t have to travel all the way into the city.” Physicians could review results with patients in video visits, he says.

“I think that kind of model is not really developed at all, and it's a real opportunity because it's a low-cost way of increasing your footprint, without having to put providers on site and all the expense that goes with that,” Rasmussen says.

Even as an outspoken advocate for digital health, he says it’s vital to ensure that patients feel like their providers are invested in their well-being.

“Healthcare at the end of the day is still a very human interaction,” Rasmussen says.

While in-person visits don’t have to be as frequent, providers can offer more frequent contact via video, telephone, or electronic communications, he says.

“I think patients appreciate closer tabs on the chronic disease using those digital means,” Rasmussen says. “And you can keep the human component as part of it.”

“I don't think medicine’s ever really going to be fully digital …  because people want that connection,” he adds. “It's a matter of incorporating the tech properly, with the human care, to bring down the total cost of care and improve the patient experience.”