Triage line screens callers for chronic disease

Program identifies members for programs

When members call a nurse triage line about a health problem, they’re at a "teachable moment" when they are receptive to taking action about their conditions, Kevin Maher, RN says.

That’s one reason McKesson Health Solutions began screening callers to its nurse triage line to determine if they may be at risk for chronic illnesses or other high-cost conditions, says Maher, vice president of product management for CareEnhance Services.

"The real power is that you are catching members at a time when they are more inclined to listen, rather than calling them on an outbound basis when they may not be experiencing any problems," Maher says.

McKesson began the screening process when an analysis of nurseline data and claims data showed that 40% of the people who called a nurse triage line had a catastrophic, chronic, or mental health claim in the year in which they called. "Health plans are looking for new value from these services. One way to get more value is to use the nurse triage line as a way to identify members who are at risk and refer them into disease management or case management," he adds.

Now when members call, the triage line nurses ask if they want to learn more about programs available through their health plan.

If the caller answers yes, the nurses conduct a mini-health risk assessment and use the data they receive as a guide to channel members into case management, disease management, wellness programs, or mental health programs.

"This enables our clients to help connect the dots and identify members with problems much earlier, rather than waiting for claims to show up," Maher says.

The program has identified a sizeable percentage of members who have a chronic condition or one that makes them eligible for case management but who have not turned up in the health plan’s programs.

About 70% to 80% agree to take the survey. Among the members who are identified to be at risk, about 70% to 80% agree to be referred to a program, Maher says.

The screening eliminates members who already are in a case management or disease management program.

The program has a high success rate because it catches the members at a time when they are concerned about their health.

"Screening tools are an excellent way to predict risk, but it’s highly effective when you use a combination of assessment tools and a motivated member," Maher says.

The nurses automatically ask all callers to participate in the screening, with the exception of those members who need to seek care immediately.

Once the health risk assessment identifies members in need of services, the triage nurse connects them to the health plan’s programs in a variety of ways, depending on the contract the plan has with McKesson.

They can be transferred directly to a case manager or, if it’s after hours, the triage nurse will find out a good time for the case manager to call the member and forward the information to the case manager.

"This does more than just take care of the immediate problem about which the member called. It identifies members who can benefit from other programs the health plan has in place," he says.