If your organization is looking to add a nurse line (or switch vendors) to better manage your patient population, you probably have a lot of questions. At Health Dialog, our 20+ years of experience in developing and implementing nurse line programs have taught us what successful clients typically require from a vendor. In this article, we discuss nine key questions you should ask your nurse line partner to assure that the program they propose is the best match for your organization.
- Who—specifically—answers calls to the nurse line, and what are their qualifications?
Your nurse line vendor should be staffed with well-qualified and experienced nurses and other clinical professionals who answer calls directly; it should not route calls through a “transfer” or “call-back” system. Patients want immediate service, especially regarding health concerns that may include making decisions about calling 911 and / or visiting the Emergency Room for themselves or other family members.
Your nurse line staff should be licensed and located in the United States. Be sure to ask for specifics on state(s) licensing, years of experience, and training activities for all nurse line staff. Some key training activities include:
- Privacy, compliance, and security awareness
- Confidentiality and ethical guidelines
- Diversity and cultural sensitivity
- Managing various types of calls
- What types of calls do you handle? How is each call supported from a clinical perspective?
Patients call nurse lines with an incredibly wide range of questions and concerns, so it’s crucial to make sure your vendor’s staff is able to handle a variety of urgent and nonurgent calls as well as assess multiple symptoms. Urgent calls might include evaluating symptoms of a heart attack or stroke, and non-urgent calls might include questions about everything from insect bites to healthcare benefits and services (e.g., transportation, local resources, etc.).
Ask your vendor how the following actions will be managed from a clinical perspective:
- Assessing symptoms and providing timely information to help make urgent, acute, or general health decisions
- Providing support and direction for seeking the appropriate level of care
- Helping individuals prepare for visits with doctors and manage self-care
Finally, request a demonstration or walk-through of the process a nurse goes through when triaging a patient call.
Check with your nurse line vendor to see if they are certified by the National Committee for Quality Assurance (NCQA) for Health Information Products or accredited by URAC for Health Call Centers, or – ideally – both. These organizations provide an independent, third-party evaluation process to ensure high-quality health services programs.
URAC specifically requires evidence that nurse line programs provide excellent coaching services and are equipped with the infrastructure to maintain high-quality internal support for health coaches. In addition, URAC ensures that the people, policies, technology, and security are in place to support a robust nurse line.
- Can you help patients navigate the healthcare system, and can your services integrate with other plan-sponsored resources?
Ensuring appropriate use of care and directing people away from the ER (when an ER visit is not clinically appropriate) are important elements of a nurse line program, but in what other ways can a nurse line help to meet your population health management goals? If your health plan provides local services like transportation, fitness classes, and support groups, make sure your nurse line vendor has processes in place to help connect your patients to these services.
In addition, your nurse line vendor should also be able to assist your patients with developing a more focused or comprehensive list of questions they should ask their providers. This will help with planning more efficient office visits, reducing knowledge gaps associated with chronic or acute conditions, and helping patients plan for or avoid hospitalizations.
- How do you handle Spanish-speaking populations and others whose first language is not English? How do you handle diverse populations?
America is a melting pot of cultures and languages. No matter what part of the country your organization is in, whether urban or rural, you’ll likely have some patients in your population who are more comfortable with a language other than English.
Depending on the demographics of your patient population, your nurse line vendor will probably need nurses who can speak fluent Spanish. Ask your vendor what percentage of the nurse line staff is bilingual (for Spanish) and how other languages are managed. See how this information stacks up against your patient population.
Also, ask about the cultural diversity training provided by your vendor. Find out how they are equipped with and trained to use tools that help engage and support diverse populations.
- How will you report on utilization of our nurse line?
The primary goal of any nurse line is to ensure the appropriate use of healthcare resources to improve clinical outcomes. Health plans often realize measurable cost-savings by simply giving their members free, 24/7 access to a reliable clinical resource.
Ask yourself what metrics you’ll need to adequately assess your nurse line program. For example, will you want very specific call-level data or a program summary, or both? You may want to know the pre-intent (for example, calling 911 or visiting the emergency room) vs. post-intent (scheduling a doctor’s appointment) of someone calling the nurse line with flu-like symptoms. Or, you may want to know how many people call the nurse line because they don’t have transportation to get to their provider’s office. These types of metrics can help you not only evaluate the nurse line program itself, but also to assess what gaps in benefits may be impeding high-quality population health outcomes. Understanding which metrics you need upfront is critical to ensure you’re getting the most out of your program.
Once you have determined what data you need, check with your vendor to see what types of reporting they offer. Be specific: Ask your vendor for standard reports that you will receive, along with their type (PDF, Excel, etc.) and frequency.
- Can you show actual results that demonstrate the success of the nurse line services?
Before hiring a nurse line vendor, ask for recent patient satisfaction rates, program performance results, and metrics associated with appropriate redirection of care.
Delivering excellent customer service is a critical element of the Star Rating Program, and just as important for general customer retention purposes. Patients view the nurse line as an extension of your health plan; therefore, assessing the patient satisfaction rates associated with a vendor’s Nurse Line program is a must.
Evaluating whether a nurse line vendor can effectively redirect patients toward less emergent level of care (when appropriate) is also essential. Our experience shows that, on average, 69% of patients with pre-intent to visit the ER or call 911 (and for whom a lower level of care was deemed appropriate) can be successfully redirected. That savings adds up because—according to a 2017 study—a visit to the emergency room cost approximately $1,389 per patient. Many of these visits are unnecessary but patients aren’t always sure what constitutes an emergency or what alternative resources are available for them to use.
- How will patients learn about the new nurse line services?
Nurse line phone numbers are often only provided in the patient’s enrollment packets, but over time these get lost or thrown away. Patients will not utilize the nurse line and reap its benefits if they forget its purpose and how to access it. Ask how your nurse line vendor will promote this benefit to your patients, and what methods will be used to effectively target this communication based on unique patient personas and profiles.
Program awareness should be established through tailored communication and engagement, and campaigns must be tailored to a population based on demographics, clinical needs, cultural differences, language fluency, past behaviors, geographic factors, and more.
Campaign pieces often include:
- General awareness letters or emails
- Seasonal and reminder postcards or emails
- Provider office flyers and posters
- What does a nurse line cost?
The cost-saving benefits of having a nurse line service are clear: helping patients better navigate the healthcare system can, in the long-run, reduce wasteful and unnecessary utilization.
The cost of working with a nurse line vendor will depend upon many factors, including the size of your population, historic utilization rates (if available), and the percentage of people who don’t speak English. Your vendor may charge on a per-call basis or per-member per-month (PMPM) basis, but the right pricing approach for each organization may be different.
Nurse lines are more complex than typical call center operations because of the extra layers of security and medical experience required to appropriately help patients. If you are planning on managing your nurse line in-house, consider that you will need to hire, train, and monitor staff. When evaluating vendors, ask whether the pricing methods they are proposing are the most cost-effective for your plan’s unique needs.
While these nine questions will help you assess the capabilities of a nurse line vendor, you need to look beyond pricing and other logistics to get a sense of the value a vendor will bring your patients. Quotes that come in much lower may be incomplete or not offer the same quality service (for example, a call-back system vs. live nursing staff). In addition, you should check references for their input on employee training, ongoing quality assurance, and overall customer service. Once you have done your homework and your nurse line is an established extension of your health care services, both you and your patients will benefit from it.