By Krithika Srivats, Vice President, Sagility Practice Office
Nurse triage is at the center of providing the right service, at the right time, by the right level of providers. The ROI can be significant for payers and providers, in terms of patient and member satisfaction and reducing costs of care for services not delivered in an appropriate setting.
A good nurse triage service that is staffed by registered nurses and others with the proper healthcare certifications can provide evidence-based, experience-based guidance on whether a current or developing condition is an immediate cause for concern, or can wait for either a call from or visit to the physician. This guidance helps members/patients make better decisions regarding care while reassuring them that their health payer and/or provider has the utmost concern for whether their needs are being met, not just during office hours but 24/7. The result is greater member/patient satisfaction and loyalty – a critical factor in a social media world where a negative comment or review can quickly go viral.
Over the years, nurse triage lines have gone through three phases of evolution. In phase 1 they were implemented to ‘check the box’ for member education, phase 2 brought “demand management” to keep patients out of the emergency room, and now in phase 3 health plans are creating a gateway to innovative programs and services.