Paving the Way for Value-Based Care: The Role of Nurse Triage in Strengthening Payer- Provider Alliances

Cheryl Dalton-Norman

The healthcare industry is at a pivotal moment where stronger collaborations between payers and providers can yield significant benefits. The relationship between improved payer-provider collaboration and high-quality, affordable care is well-established. However, findings from the American Hospital Association (AHA) reveal variations in the development of true partnerships for value. One notable challenge is the historical distrust between payers and providers. Overcoming this hurdle is crucial for unlocking the full potential of collaborative efforts.

In an article with MedCity News, Cheryl Dalton-Norman, president of Conduit Health Partners, shares how Conduit Health Partners’ Nurse-First triage serves as bridge to build stronger payer and provider alliances.

Nurse Triage as a Catalyst for Value:

Nurse triage emerges as a powerful tool that can bridge the gap between payers and providers. This solution involves patients talking to a nurse by phone to determine the necessity and setting of care, proving effective in reducing unnecessary emergency department (ED) visits. The value of nurse triage extends beyond immediate connections, contributing to shared goals that advance quality of care and clinical outcomes.

Addressing Social Determinants of Health:

The Centers for Medicare & Medicaid Services’ Framework for Health Equity emphasizes the importance of identifying and acting on social determinants of health (SDOH) to ensure high-quality care and reduce healthcare costs. Nurse triage, with a registered nurse as the first point of contact, becomes instrumental in identifying SDOH such as transportation needs and food insecurity, ensuring timely and appropriate care.

Decreasing ED Utilization:

Staffing shortages and increased patient demand are straining emergency departments, driving up healthcare costs. Nurse triage offers a solution by ensuring that patients receive the right care at the right time and in the most appropriate setting. Real-world examples demonstrate a significant decrease in ED utilization, leading to both cost savings and improved patient outcomes.

Consumer-Friendly 24/7 Access and Support:

In today’s healthcare landscape, consumers expect 24/7 access to quality care. Nurse triage provides a consumer-friendly solution, offering immediate evidence-based care through a registered nurse on the first contact. This not only meets consumer expectations but also helps build trust and loyalty among patients for both payers and providers.

A Value Differentiator:

Nurse triage emerges as a value differentiator for payers and providers seeking to strengthen their partnerships. By involving a registered nurse from the outset of a patient encounter, clinical and cost outcomes naturally improve through timely assessment and appropriate care delivery. This proactive approach can lead to long-term benefits for all stakeholders involved.

The healthcare industry can benefit significantly from stronger payer-provider partnerships, and nurse triage initiatives serve as a catalyst for collaboration. Overcoming historical distrust, addressing social determinants of health, reducing ED utilization, and providing consumer-friendly 24/7 access are key elements that contribute to the success of these initiatives. As the industry works towards tearing down barriers, the stakeholders should consider the opportunity to embrace nurse triage as a transformative solution for delivering high-quality, affordable care.

Contact us today to learn how Conduit Health Partners can help your organization.