By Payton Babb Sy, RN BSN
Research shows that 20% of patients with serious health problems are initially misdiagnosed- which results in nonessential and expensive procedures. These unnecessary treatments cause overutilization, where healthcare services are rendered at a higher cost or volume than appropriate.
Behind every case of overutilization is a patient that needs to be heard. Not every plan member is confident that their spine operation won’t be the first of many failed surgeries, or that it’s the right time for a knee replacement. A second opinion helps them determine the next best decision.
MRIoA offers a telehealth second opinion benefit for health plans called MyCareChoices™- Telehealth 2nd Opinion . Sybel Beattie, RN-CLNC has experienced helping these members. As MRIoA’s director of nursing services and the patient-centered face behind the program, she recounts, “These patients are wondering, ‘have I done enough?’ and ‘do I know enough?’ Nobody but them can make that call”.
Education Through Interactivity
Challenges with current authorization processes leave members vulnerable to overutilization.
- Most medical office visits are cut down to 15 – 20 minutes
- The course of treatment is often determined after just 1 visit
- Members assume that the coordination between their health plan and medical provider will always result in the appropriate authorization
MyCareChoices™- Telehealth 2nd Opinion fills education gaps for members to make informed decisions.
- Members receive access to an interactive portal and instructional video
- Questionnaires are provided to determine the member’s concerns
- A media series details their procedure, as well as possible alternatives, risks, and benefits
Holistic Patient Care
The member’s second opinion specialist creates one report in member-friendly language, and an additional report designed for the member and their medical provider to review together.
The report is created based on the following elements:
- The number of times they’ve watched each video on their treatment and alternatives
- Submitted clinical documentation
- Answers to their questionnaire
MyCareChoices™- Telehealth 2nd Opinion brings a human touch back into prior authorizations. Mental health, comorbidities, and family history are all considered to embrace holistic care. Each report is supported by current medical literature and cited in the review.
Empowerment to Make Care Choices
The member’s report outlines the content of their 1:1 consultation with an MRIoA MyCareChoices™- Telehealth 2nd Opinion nurse or provider. The member can ask questions and verify their understanding of the recommended treatment during the visit.
After the member completes the program:
- 48% of members end up making a change to their treatment plan
- Members save out-of-pocket costs and recovery time
- MRIoA guarantees health plans and TPAs a 3:1 return on investment
MyCareChoices™- Telehealth 2nd Opinion is a benefit that allows payers to be patient advocates while reducing unnecessary costs.
The Bottom Line
One in six members wants a second opinion. Members may wait months to see a specialist while navigating their care alone. In contrast, MRIoA generates a second opinion report through MyCareChoices™- Telehealth 2nd Opinion in just 24 – 48 hours. Sybel reflected, “It’s a common thread in the story. Whether or not the patient chooses to go ahead and have the procedure, they feel more confident, engaged, and informed”.
MyCareChoices™- Telehealth 2nd Opinion offers the solution that both payers and members are seeking: hearing the patient voices behind overutilization.
How would second opinions transform your health plan? Contact us to learn more.
MyCareChoices™- Telehealth 2nd Opinion Powered by Medical Review Institute of America
