Using Nurse Lines to Improve Healthcare Navigation

Health Dialog


Nurse line coaches help members get access to the care they need

How to Connect Patients to the Benefits and Services They Need Most

It’s a well-known fact that telephonic nurse lines are effective in delivering clinical information to patients and ensuring appropriate use of care. While the average ER visit costs roughly $1,3891 per patient, health plans can often realize measurable cost-savings by simply giving their members free, 24/7 access to a reliable clinical resource. In fact, according to Health Dialog’s data, up to 68% of members who call a nurse line with the intent of going to the emergency room (ER) or dialing 911 can be re-directed to a less emergent level of care.

However, nurse lines are more than just clinical call centers that help patients evaluate their symptoms. For those patients who struggle to navigate the healthcare system, nurse lines can help bridge the gap.

Specifically, nurse lines can also help members:

  • Access plan-sponsored benefits and resources that he or she may not even realize they have, such as case management, disease management, telehealth, mental health, wellness programs, second opinion services, online portals, mail order pharmacies, transportation, and more.
  • Identify community centers, apps, online tools, and other resources that can support immediate and long-term health needs. For instance, some plans offer complimentary fitness classes at local YMCAs and use their nurse line to help spread the word to callers when appropriate.
  • Eliminate knowledge gaps associated with chronic or acute conditions and help them plan for or avoid hospitalizations.
  • Develop a more focused or comprehensive list of questions they should be asking their providers for more efficient office visits.
  • Improve medication-taking skills, better understand therapeutic guidelines and drug interactions, and identify plan-approved resources or programs that can help eliminate barriers to adherence.
  • Promote services, programs, and vaccinations that can reduce gaps in care or improve HEDIS and STARS quality measures. For instance, some health plans use nurse lines to remind patients of yearly flu vaccinations.
  • Schedule appointments for necessary services.

When implemented correctly, nurse lines can serve as critical junctions between health plans and their members. However, effective integration of this service with other health plan resources is key. When working with outside vendors, there are 4 critical integration best practices that ensure a seamless experience for members:

  • Integration begins during the implementation process: At the start of the relationship, health plans and nurse line partners must share critical information to ensure a unified approach to member management. A detailed list of all programs, resources, and benefits available to member populations can help nurse line partners better coordinate care at the individual level.
  • Staff training is foundational to success: Training team members on how to deliver a cohesive and effortless consumer experience is key. Members expect a fast, easy, and effective interaction that allows them to connect with the services and support they need. This requires all customer-facing team members, whether it be your vendor’s nurses or your in-house case managers or customer service representatives, to follow the same protocols.
  • Implement technologies that ensure seamless interactions with members: Facilitating quick and easy call transfers of members from one team to another and ensuring members have access to digital tools for contacting various teams from a single, easy to use application are both a must.
  • Make use of reports and dashboards that outline vendor metrics and results: Insights from nurse line partners (including utilization metrics, top reasons or symptoms for calling, number of calls transferred, key barriers to care, summary member call details, etc.) can help plans improve their own programs and services and identify any gaps impacting member coordination and health outcomes.  

Helping each and every member navigate the complexities of the healthcare system can be a daunting task, but nurse lines have proven effective in closing communication and coordination gaps. To ensure utilization of this service, health plans cannot skimp on strategic marketing and communication tactics that increase awareness of this valuable service.

Recently we conducted a survey asking healthcare consumers how they manage their health when their need quick access to care. To see the results, check out our infographic on healthcare access and preferences.



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