You may have heard the phrase ‘if you build it, they will come,’ popularized by the 1989 film, ‘The Field of Dreams.’ The problem is that this strategy only works in baseball fantasy. Launching a second opinion program is not so different from starting a new branch of business. Simply beginning to offer second opinions as a formalized service does not mean that patients will show up. In other words, if you build it - they will not necessarily come.

This is in line with what we sometimes hear from even the most highly regarded health institutions, who complain that their second opinion program established years ago, has yielded disappointing results. While their program draws low volume and little financial return, they see other peer programs are thriving with bona fide patient flow and revenue streams to prove it. So what’s the difference? 

If you are in this situation, you are not alone. Most of these programs were established by a concierge service. A concierge is an entity that services certain populations of patients’ healthcare needs and establishes second opinion programs with hospital partners to achieve this goal. These programs are usually branded with their name or co-branded together with the institution. These programs begin with the intention for the concierge to send cases to the hospital from their pool of patients. The costs and risks were low for the hospital. But in many cases, these programs have failed to generate the number of cases that hospitals expected. Here’s why:

1. Concierges Do Not Have a Stake in Growing Your Volume

Concierges, who established these original plans, have no real stake in your second opinion program’s success. The medical opinions generated by your hospital are the product that the concierge is selling to its established patients. The actual business of a medical concierge is to offer your well-regarded hospital services to their patients (usually the high net worth type) when and if their patients require it. Since your hospital is well known for high caliber medical skill and experience, these concierges established a program at your hospital to tap your reputation when they need it. 

As these concierges sign-up more hospitals, allowing them to offer a wider range of specialties, their patient base becomes spread across more hospitals – meaning that you continually get a smaller percentage of their patient population. If patients other than their own also found their way into the program, that was just gravy. But their strategy is not to generate outside demand for second opinions at your facility. While these programs are typically  a low cost / low risk endeavor for hospitals, it is unrealistic to expect them to deliver on volume.

2. There is No Public Facing Demand Generation 

Research shows that patients spend more than half of their time researching medical opinions on the web prior to engaging a human. Since it was not within your concierge’s set of services to create a public facing second opinion program or process for helping patients outside of their client list to navigate this process, other patients are left in the dark. In many cases, there is no clear identification of the second opinion program on the hospital’s website and no easy way to find it on the web.  If a patient does stumble across an existing second opinion page, it is often branded with the concierge’s URL and logo, further confusing them. Without specific SEO hooks and landing pages designed to highlight your hospital’s brand, specialties, and treatment options, patients are left unaware of where to go and how to start.

3. Internal Buy-In and Support is Missing

Without a proactive strategy and internal marketing, many hospitals find that their staff does not understand the benefits to supporting and growing the program. Concierges often directly pay physicians a stipend for completing an opinion. This is commonly referred to as “coin operated,” meaning that the physician’s action is induced directly by the expected payment. Sometimes hospitals establish several different concierge referral programs that each require your physicians to use a different platform reducing their efficiency and often leading to frustration. 

While the stipends earned may be  good for interested physicians, it does little to establish second opinions as a strategy. Ensuring that your clinical teams understand where these fit within the overall hospital strategy is an important part of supporting program growth. Your staff is often a good source for referrals, and ensuring they see a well-lit path to your program is critical to your traffic.

4. Concierges Are Not Intended to Address Health Equity

If health equity is important to your hospital, using a concierge as the only avenue for providing second opinions accomplishes the opposite. It is no secret that concierge patients are wealthy individuals, such as corporate executives and their families, who can afford these “white glove” services. So it is not surprising that relying on concierge only leaves out the other “99%” of the patient population.

5. Insurance Reimbursement for Second Opinions is Complicated

Most remote second opinions today do not currently qualify for insurance reimbursement or are difficult to obtain. Still there is a substantial slice of patients who are not served by a  concierge, but wouldn’t think twice about paying for a second opinion out of pocket if their or their child’s medical issue was critical. Leveraging the opportunity to obtain a second opinion before deciding to undergo a procedure could save them time and money in travel, childcare, and time off work…and perhaps their lives. Many won’t stop without identifying the top expertise for their condition, and are willing to travel across the globe to have access to that specialist. But first they want to know whether it’s worth it, and what you can do for them. 

Of course, there are even less privileged populations who will require ways to subsidize second opinions. We expect to see government payers as well as private payers including these in a covered charge in the not-too-distant future.  In the meantime, we encourage hospitals to partner with foundations and nonprofits to help fill this need, allowing second opinions to emerge as an equitable service.

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The demand for medical second opinions is large and increasing. According to Insight Partners the US market is expected to reach almost $11 billion by 2027 with the online segment growing fastest.   Hospitals are considering virtual second opinions as a pathway to patient engagement or as an integrated component of their telemedicine and digital health programs. Simply relying on a concierge relationship (or two) is likely not the pathway for an strategic and robust second opinion program.