The relationship between improved payer-provider collaboration and high-quality, affordable care is well-established, but the degree to which health systems and health plans develop true partnerships for value varies, a recent American Hospital Association (AHA) executive dialogue found. While progress has been made in some areas, there is one notable challenge: a long history of distrust between payers and providers.
For example, the AHA reports that while some payers openly share data with providers in the move toward value and risk-based contracts, others are hesitant or unwilling to align technology investments around greater transparency. One proven way payers and providers can find common ground is through shared strategies that advance care access and health equity goals while also driving more proactive, appropriate care delivery.
Nurse triage enables patients to talk by phone with a nurse to determine whether care is needed, whenn and in what setting. This solution is becoming a key path to value for both payers and providers. It helps reduce unnecessary emergency department (ED) visits while ensuring patients receive the answers they need, through the simplicity of a phone call.
The value of nurse triage extends beyond connections made in the moment. When deployed effectively, nurse triage can also serve as a natural step toward achieving numerous shared goals that advance quality of care and clinical outcomes. Here are three ways a nurse triage initiative between payers and providers can strengthen value:
- Addressing social determinants of health
With the release of the Centers for Medicare & Medicaid Services’ Framework for Health Equity, the ability of payers and providers to identify and act on social determinants of health (SDOH) will be central to ensuring high-quality care for all patients while also driving down healthcare costs. Establishing a registered nurse as the first point of contact for patient triage is proving to be an impactful driver in identifying social determinants such as transportation needs and food insecurity, ensuring patients receive timely care in the most appropriate setting.
Research shows that nurse triage programs help patients with chronic conditions, who are also impacted by social determinants of health, to be more compliant with managing their health and following their treatment plans. This leads to significant improvements in healthcare outcomes and quality of life. Triage can not only address patient needs in the moment but can also be used to uncover gaps in care related to health screenings and other preventive measures.
- Decreasing ED utilization
A perfect storm over staffing shortages and increased patient demand for services is straining emergency departments. It’s also driving up healthcare costs when many patients could be more appropriately treated at an urgent care clinic or by their primary care physician. And some may not need care beyond a phone assessment by a Registered Nurse.
When nurse triage is available, there is greater certainty that patients will receive the right care at the right time in the most appropriate setting. Patients and families acting on health issues without appropriate consultation are much more likely to choose a higher level of care than needed. This reality not only drives up healthcare costs but also produces a significant impact on a patient’s finances. Consider that the average out-of-pocket cost for an ED visit exceeds some household’s liquid assets, according to a Kaiser Family Foundation analysis.
Nurse triage is a proven remedy to decreasing high-cost ED utilization as evidenced by the below results:
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- One large Midwest health system with 35,000 covered lives decreased ED utilization from 242 visits per 1,000 employees to 192 visits per 1,000.
- Another large health system with 65,000 covered lives decreased ED visits from 229 visits per 1,000 employees to 176 per 1,000.
- Offering consumer-friendly 24/7 access and support
Payers and providers alike are striving to ensure 24/7 access to quality healthcare for all patients. Today’s consumers expect to access care when they need it and where they need it—not always during standard office hours for physician practices or even urgent care centers, which often close at eight or 10 p.m. With a 24/7 nurse triage phone solution, after-hours care that connects the patient to a registered nurse on the first contact, provides immediate evidence-based care, which helps build trust and loyalty among patients, for their payer and provider. It also helps relieve burned-out physicians from after-hours call duties.
A value differentiator for payers and providers
The healthcare industry stands to benefit greatly from stronger payer and provider partnerships. As the industry works to tear down the barriers that currently exist to bringing these stakeholders together, there are mutually beneficial opportunities that should be considered now. By involving a registered nurse from the outset of a patient encounter, clinical and cost outcomes will naturally improve through more timely clinical assessment and appropriate care delivery.
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