Nurse Triage for Health Plans
Health plans must manage healthcare costs. They understand that one of the keys to doing so is ensuring members are quickly directed to the right level of care when they are sick or hurt.
Commercial, Medicare and Medicaid health plans turn to nurse triage services to staff their member nurse lines and provide 24/7/365 access to experienced registered nurses (RNs).
Nurse Triage Benefits for Health Plans
Health plans recognize that members sometimes need help navigating today’s complex healthcare system and its many options — Telehealth? Office visit? Treat at home? Urgent care? Emergency department or room (ED or ER)?
Nurse triage services — sometimes called nurse lines — support members in making the right choices for their care based on evidence-based protocols. As a result, nurse triage services help:
- Lower healthcare costs for both members and health plans.
- Reduce unnecessary emergency department visits.
- Prevent avoidable readmissions of members newly discharged from the hospital.
- Improve access to care wherever members are and at any time of the day.
- Enhance member satisfaction.
- Diminish disparities in healthcare caused by socioeconomic status, geography and uneven health literacy.
Further, nurse triage services by Conduit Health Partners can support members who speak languages other than English (300 languages, in fact), so they can help direct all your members to the appropriate providers.
Quality Nurse Triage for Health Plans
Avoid Unnecessary ED Visits
How a Midwestern health plan increased emergency department avoidance by nearly 90% among members who called nurse triage services.
Offer Immediate Access to Care
When members know they can call a number and be connected immediately to a nurse, the effect is remarkable, according to Conduit Health Partners’ president and co-founder.
Measure & Track Results
Numbers matter to health plan leaders, and Conduit Health Partners helps you measure and track progress toward your goals.
At Conduit Health Partners, our co-founder and many of our leaders began their careers in nursing.
We understand how well nurses can connect with commercial, Medicare and Medicaid plan members, earn their trust and see that they get the care they need.
- With our nurse triage services, experienced and licensed RNs answer members’ calls around the clock, 365 days a year.
- They use evidence-based decision-support tools (the Schmitt-Thompson protocols) to evaluate members’ situations.
- Using the health plan’s network and range of services, triage nurses direct members to the appropriate care.
- Health plans can access daily reports of calls and dispositions so care managers or medical teams can follow up with members and their healthcare providers.
Conduit Health Partners nurse-first triage is URAC-accredited, so you can be confident of the quality of support your members receive. Members appreciate that their health plan is invested in their well-being and makes it easy for them to reach a nurse 24/7/365.
Our Results Attest to Our Effectiveness and Quality
Our clinical team works closely with you and provides access to detailed reports on calls and resolutions. Experiences with large organizations nationwide have led to solid results and satisfied patients and members.
Nurse Triage Services Reduce Unnecessary Emergency Visits
When members feel sick or have been injured, they can be distressed and frightened — and ill-equipped to decide the appropriate place to get care. Many end up in emergency departments because they know those facilities are open and staffed with healthcare professionals.
Health plans and members, however, pay the costs of unnecessary ED visits and higher healthcare costs along with delays due to overcrowding and staff shortages. Integrating nurse triage services helps reduce unnecessary ED visits so that only those who truly need emergency care are directed to EDs.
When health plans engage a nurse triage service, they can advertise to their members a phone number where they can always reach a nurse and get expert guidance about what care they need.
Triage nurses working on behalf of health plans can help members find available healthcare resources within their plan’s network. In addition, triage nurses address members’ concerns, educate them and assure them of their ability to get appropriate and timely medical attention.
Nurse Triage Services Increase Member Satisfaction and Reputation
Health plans want their members to understand and believe that they are committed to having them live their healthiest lives. Adding triage nurses to your health plan’s array of member support services can improve satisfaction ratings and enhance your reputation in the markets you serve.
Increasingly, member satisfaction ratings can affect health plans’ reimbursements by government programs such as Medicare and Medicaid. A commercial customer, such as an employer or labor organization, also considers member satisfaction ratings when renewing contracts or seeking new bids.
Conduit Health Partners has a superior track record in the category of member satisfaction: A 2023 survey of all individuals who accessed Conduit Health Partners nurse triage services found that 99% were satisfied with their experience.
Nurse Triage Teams Support Health Plans' Care Managers and Medical Teams
Health plans typically have care managers and medical teams who become involved in complex cases and in seeing that members with chronic diseases — like diabetes, kidney and heart disease and many cancers — are getting the proper care.
Outsourcing nurse triage services adds a trained, on-call “front line” to those teams. Triage nurses log details of every member call and disposition. Health plan care managers and medical teams have access to data and reporting so they know if they need to follow up directly with members or alert the members’ healthcare providers.
Helping Health Plans Outsource Nurse Triage Lines
The advent of managed care 50 years ago touched off the evolution of health plans from claims processing businesses to organizations that partner with members and healthcare providers to produce better outcomes and manage costs.
Today, healthcare’s challenges are amplified by shortages of doctors and nurses, prompting new approaches to resourcing and the decisions by many health plans to outsource services like nurse triage.
Outsourcing nurse triage services to Conduit Health Partners helps health plans:
- Save on staffing, continuous training and extensive technology needed to operate nurse triage services.
- Address the shortage of qualified RNs nationally and particularly among under-served populations.
- Gain a specialized partner that ensures triage nurses receive regular training to maintain competency to ensure top-quality care.
It’s no wonder that outsourcing is a growing trend among health plans of all kinds — self-insured and fully-insured commercial plans and government-supported Medicare and Medicaid plans.
Choose a Leading Nurse Triage Company for Your Health Plan
Conduit Health Partners understands the healthcare system from all angles – providers, payers and patients. By tapping the clinical expertise of RNs, we connect everyone in a circle of caring dedicated to delivering better outcomes at lower costs.
Our leadership team is made up of experienced nurses and healthcare administrators committed to helping health plans:
- Lower costs by helping members get the right level of care without delay.
- Avoid inappropriate ED use and the associated costs for members and health plans.
- Improve healthcare access for members affected by disparities in the healthcare system.
- Boost member satisfaction and health literacy.
- Enhance the plan’s reputation among its customers and within the markets it serves.
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Learn More About Conduit's Nurse Triage Services
When you hire nurse triage from Conduit Health Partners, your team includes an account manager dedicated to your organization and a team of experts in clinical care, call center operations and technology.
We serve hundreds of thousands of individuals nationwide through our contracts with employers, health plans, hospitals and medical practices. We’d welcome discussing how we might help your health plan.
Contact us for a no-obligation consultation
Call us at 855-605-2833 or fill out our form to schedule a meeting with a member of our leadership team.
1 2023 Conduit Health Partners Triage Service (combined clients)
2Based on a panel of 50,000 individuals with 5% utilization of Conduit Health Partners nurse-first triage. The total savings was $250,000 on a $75,000 investment in the service.
3 2023 Conduit Health Partners Post Call Survey (combined clients)
4 Assuming 71% of ED visits are unnecessary, and an average ED visit costs $1,250, a health plan or self-insured employer can save $88,750 per 100 contacts with nurse-first triage.
Frequently Asked Questions about Nurse Triage Call Centers for Health Plans
Few professionals are as admired and trusted as nurses. Health plans understand that and operate nurse lines to help direct their members to professionals they trust so they can get the proper care.
Nursing shortages, however, have made it more difficult for health plans to staff their triage nurse lines 24/7/365. At the same time, health plans recognize that economies of scale make it wise to consider an outsourced solution like Conduit Health Partners for nurse triage services.
By providing members with a phone number to triage nurse services, health plans can see that members are evaluated using evidence-based protocols and directed to the right level of care.
Many times, however, there are more appropriate options, such as in-network telehealth, urgent care, appointments with their specialty or primary care providers or informed home care.
One sizeable Midwestern health plan used nurse triage services and:
- Improved ED avoidance by nearly 90%.
- Earned a 96% member satisfaction rating.
Overuse of the emergency department is a widely acknowledged driver of costs in the healthcare system, adding billions of dollars unnecessarily to healthcare costs.
By one estimate, 71% of ED visits are unnecessary. Assuming an average ED visit cost of $1,250, a health plan can save $88,750 per 100 contacts with nurse-first triage. Based on a panel of 50,000 members, we estimated a 3:1 return on investment in nurse triage services.
Of course, every health plan’s membership is different. That’s why Conduit Health Partners works with health plans to evaluate when and how its members may be misusing emergency services and work collaboratively to develop possible solutions and metrics by which those solutions will be evaluated.
Not all members have a primary care provider they know and trust. Some members may live in areas with few options, like urgent care or walk-in clinics, to use when they get sick or injured.
However, all members have a phone they can use to reach a triage nurse. Health plans that activate their membership to call their nurse lines when they have questions can reap the benefits of lower healthcare costs and higher member satisfaction.
The challenges of health care today are leading more payers (health plans) to form alliances through outsourcing with various healthcare services, including nurse triage services, remote patient monitoring and member outreach and engagement.
With their years of experience in various healthcare settings, Conduit Health Partners’ leaders understand the value of everyone invested in member health and safety collaborating in novel ways. We think of ourselves as “smokejumpers” who are fearless in attacking healthcare’s most perplexing challenges with vigor and hope.