Health plans are increasingly recognizing the importance of helping members navigate their health. With options ranging from telehealth to urgent care to emergency department visits, members often need guidance to make the right care choices. Nurse-first triage solutions can serve as a win-win for health plans, offering a tool to improve health outcomes for their members while decreasing overall health care costs for their organization.
Five ways that nurse triage can help improve health outcomes of health plan members include:
1. Ensures Immediate Access to Expert Medical Advice
Nurse triage services ensure that members have immediate access to clinical advice from a registered nurse around the clock, regardless of their location. This access not only addresses members expectations for guidance but can prevent minor health issues from escalating into serious conditions. By providing consistent and immediate access to care, nurse triage enhances member satisfaction and promotes timely medical attention, which is critical for improving health outcomes.
2. Promotes Efficient Use of Health Care Resources
Emergency department visits are often the default choice for members who are unsure about the severity of their symptoms. With nurse-first triage, members can be directed to the appropriate level of care based on their symptoms. In many cases, this helps to avoid unnecessary visits to high-cost settings like emergency departments. A case study from a Midwestern health plan demonstrated nearly a 90% reduction in unnecessary emergency department visits among members who used nurse triage services. This not only alleviates overcrowding and reduces strain on emergency departments but also minimizes costs while ensuring members receive the ideal care.
3. Prevents Avoidable Readmissions
Readmissions can be a major cost driver for health plans and a source of stress for members. Nurse triage services play a crucial role in preventing avoidable readmissions by offering post-discharge support and follow-up care. By ensuring members adhere to their discharge plans and promptly addressing any arising issues, nurse triage helps keep members on track and reduces the likelihood of readmission.
4. Addresses Health Care Disparities and Enhances Member Satisfaction
Healthcare disparities due to socioeconomic status, geography, and health literacy can significantly impact member health outcomes. Nurse triage services help bridge these gaps by offering personalized advice and support ensuring all members receive appropriate care. Additionally, members appreciate the ease of access and the reassurance provided by nurse triage services, leading to higher satisfaction rates. Health plans benefit from improved member satisfaction scores, which can positively impact reimbursement rates from government programs and attract more commercial customers.
5. Supports Health Plans’ Care Managers and Medical Teams with Complex Cases
Health plans typically have care managers and medical teams who become involved in complex cases and in seeing those members with chronic diseases — like diabetes, kidney and heart disease and many cancers — are getting the proper care. Outsourcing nurse triage services adds a trained, on-call “front line” to those teams. Triage nurses log details of every member call and disposition. Health plan care managers and medical teams have access to data and reporting so they know if they need to follow up directly with members or alert the members’ healthcare providers.
Improve Health Outcomes for Health Plan Members with Conduit
Nurse triage services offer a powerful tool for health plans aiming to enhance member health outcomes and reduce costs. By providing immediate access to medical advice, promoting the efficient use of health care resources, preventing readmissions, addressing healthcare disparities and supporting teams with complex cases, nurse triage supports health plans in delivering high-quality, cost-effective care.
Conduit Health Partners, with its experienced team and comprehensive nurse triage services, stands out as a reliable partner for health plans looking to optimize their care delivery and member support. By integrating nurse triage into their services, health plans can achieve better health outcomes, greater member satisfaction, and a stronger reputation in the marketplace.
