Plans reap big benefits from nurse triage services

Interventions can impact members’ care

Nurse triage services offered by health plans can improve members’ access to care, reduce unnecessary or avoidable emergency department (ED) and physician office visits, improve members satisfaction, and proactively identify members in need of case management or disease management services. Consider these statistics:

In a survey conducted for Intracorp, a health and disability management firm based in Philadelphia, 65% of plan members who responded said their health care actions were influenced by a conversation they had with a nurseline specialist.

In one pilot program, McKesson Health Solutions increased enrollment in an asthma disease management program by more than 30% by identifying people through its nurse triage line.

A third of members using either Intracorp’s nurseline or case management services said the program increased their overall satisfaction with their health plans.

Both Intracorp and McKesson Health Solutions provide nurse triage lines and other services to a variety of clients, including payers.

Representatives of both companies report that their clients have found the nurse triage lines beneficial in directing members to the appropriate level of care.

"Data from the National Center for Health Statistics and the Agency for Healthcare Research and Quality show that 54% of emergency room visits are for nonurgent care and that nearly 60% of physician visits are for information and reassurance vs. hands-on care," says Kevin Maher, RN, vice president of product management for CareEnhance Services at McKesson Health Solutions.

Purchasers of nurse triage services typically want to improve their membership’s access to care and reduce unnecessary and avoidable ED and physician office visits, Maher says.

"Members should be able to get health care information through the provider network, but after hours and on weekends, it can be a challenge," he adds.

That’s why nurse triage lines can be useful in providing information to consumers that helps them avoid a visit to the physician’s office, or redirecting their care to a venue less intensive than the ED, he adds.

The goal of a nurse triage service is ensuring the health of the caller, which may mean treating a medical condition at home, the physician’s office, or the ED, whichever makes the most sense for the condition described by the health plan member, Maher says.

"Nurse triage lines help the consumer decide if an acute medical condition should be handled at home or at the emergency room," he adds.

The savings can be substantial, says Kathleen M. Leone, vice president, utilization management for Intracorp’s Health Care Management unit.

Intracorp partnered with CIGNA HealthCare and Watson Wyatt, a human resources consulting firm, for a study to quantify the value of health information lines.

The researchers concluded that a call to a health information line or nurse triage line reduced costs for the majority of 10 conditions evaluated because the callers were guided to an appropriate level of care.

During the eight-month study, Watson Wyatt identified the top 10 conditions about which members called the health information line. They compared claims data on the 10 conditions from eligible members who called the health information line and those who did not.

The top conditions were abdominal pain; sore throat; chest pain; trauma — lower extremity; fever; cough; trauma — bone, ligament, or muscle; flulike symptoms; earache/ear pain; and backache/back pain.

In all conditions except chest pain, the outpatient cost was lower for those who called the health information line than for those who did not. In the case of chest pain, the researchers concluded that the callers were triaged to a more intense level of care, which was appropriate.

In many cases, the savings were significant. For instance, with lower trauma, the average outpatient cost per caller was $52.55, compared to $218.53 for those who did not call the health information line. For people complaining of fever, the cost was $111.80 for callers vs. $236.95 for noncallers.

In another study, when McKesson Health Solutions merged the claims data records with patient call records for three different health plan clients, one of which has 4.4 million members, the researchers discovered that about 40% of people calling the nurse triage line had had a chronic, catastrophic, or mental health claims in the year in which they called.

As a result, callers to McKesson’s nurse triage lines now are asked to participate in a mini-health assessment screening. If they appear to be at risk for chronic illnesses, they are referred to the health plan’s case management or disease management programs.