24/7 nurse-first line improves clinical outcomes for one of Ohio’s largest health insurance companies

Health concerns don’t stick to a 9-to-5 schedule. Medical Mutual sought a better solution to provide its members quick access to reliable clinical advice, any time of the day.

OPPORTUNITY TO IMPROVE

Medical Mutual partnered with other 24/7 nurse line service providers in the past, but its members weren’t getting the level of support they needed. The process was often cumbersome. Callers went through inefficient triage procedures, which seemed to create member frustration and increase the likelihood to hang up. Previous services lacked the timely, clinical expertise necessary to prioritize members to the appropriate levels of care. In addition, previous solutions struggled with integrating their services with Medical Mutual’s population health model. Medical Mutual sought a better solution to give its members quick access to reliable clinical advice, any time of the day.

THE NEED

A robust, integrated, flexible and timely call management system is critical when managing a high volume of clinical calls. Members need peace of mind that if a medical issue or question arises, a registered nurse is available to help 24 hours a day, 7 days a week, 365 days a year. Around-the-clock nursing support not only increases member satisfaction, but it decreases the likelihood of unnecessary and potentially costly visits to the emergency department.

THE SOLUTION

Conduit’s URAC-accredited 24/7 nurse-first line uses a HIPAA-compliant, customizable process to help Medical Mutual meet the unique needs of its members that uses the Schmitt-Thompson industry-standard protocols. Registered nurses use evidence-based clinical protocols to evaluate callers’ symptoms and concerns and understand the urgency of needed care. Conduit further supports Medical Mutual’s members after the initial call by helping them schedule appointments for primary care services. Using a patient-centered approach, nurses help the caller determine the right level of care, at the right time, and in the right setting, all while supporting members’ long-term health improvements through integration with Medical Mutual’s population health model. Additionally, Conduit regularly shares data and interacts with Medical Mutual’s clinical care team to identify and support members with rising health risks, high emergency department prevalence and immediate care management needs.

THE BENEFIT

Since Conduit partnered with Medical Mutual in January 2020 to provide its 24/7 nurse-first line, call hold times and abandonment rates have significantly decreased and member satisfaction has increased. Nurses helped more members locate and schedule the appropriate level of care for their individual needs and many members avoided costly trips to the emergency department.

RESULTS

In Medical Mutual’s first year using the 24/7 nurse-first line, almost half of the callers who intended to go to the emergency department were seamlessly redirected to more appropriate levels of non-emergency care after their conversations with experienced nurses. Overall, Medical Mutual has seen their emergency department avoidance rate increase to nearly 90% since partnering with Conduit in 2020.

Conduit’s 24/7 nurse-first line has resulted in more timely advice and improved care, while supporting financial savings for Medical Mutual and its members.

Low Call Abandonment Rate
ED avoidance

“Conduit is a great partner. Their highly trained nurses serve as an extension of our own clinical team. The high level of expertise and diverse services they bring to the table help our members receive care in the proper setting, increase the level of service provided to our members, and support our ability to scale portions of our population health model.”

TERE KOENIG, MD, MBA
Medical Mutual Executive Vice President and Chief Medical Officer

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