By Dusti Browning, MSN, RN, NE-BC
Already unsustainable care costs will rise yet another 5% or higher this year—not including the jump in premiums many companies have seen. To counter the impact, one out of five employers point to utilization control services, including nurse advice lines that can help steer employees to the right care in the right location, as the most effective options for decreasing expenses.
For two large employers, one type of nurse advice line—a nurse-first remote triage model—reduces unnecessary emergency department (ED) and urgent care visits. It’s an approach that lowers healthcare costs for both employees and employers and helps minimize readmissions by offering patients clinical support when they need it, including after hours.
The need for ED utilization solutions
The need to curb unnecessary ED utilization isn’t just a concern for payers and employers. It’s also a priority for healthcare organizations.
While ED nursing shortages existed long before COVID-19, the prolonged stress of the pandemic—combined with the pressures of working in an emergency care environment—have prompted a higher percentage of nurses to leave the ED. “No region in the U.S. has been spared the consequences of an acute nursing shortage in the ER,” NurseJournal reports.
With fewer staff, patients may wait hours to be seen in EDs, increasing the risk that their condition may deteriorate. This makes solutions that help lower ED volumes by helping to ensure only patients with urgent or emergent healthcare needs seek care in this setting all the more valuable.
There is also the matter of cost. The average out-of-pocket cost for an ED visit exceeds some households’ liquid assets, according to a Kaiser Family Foundation analysis. Given that one out of 10 employees from large employer groups seek care in the ED, providing safe and effective alternatives for employees and their families to receive care and care guidance is crucial to making healthcare costs more manageable for all.
How a nurse triage model could help
A recent study indicates certain vulnerable populations are more likely to seek care in the ED, with lower-income households and those who do not have college degrees more likely to go to the ED for preventable reasons. For these populations, a combination of nurse-first triage, patient education, and community support not only holds strong potential to reduce emergency care costs, but also improve patient flow.
Under a nurse-first triage model, employees call a 24-hour service staffed by registered nurses before heading to an urgent care or ED to determine what care is needed and where to receive it. During off-hours, they also gain professional advice on whether to seek care right away—and where, including in an urgent care center—or whether they can safely wait to see their primary physician. When patients do need emergency care, a nurse will provide the recommendations as well as care advice to manage the symptoms until the patient can be seen.
Nurse-first triage helps support optimal utilization of care resources. It also promotes self-efficacy through education for symptom management.
More and more, employers and health plans are relying on nurse-first triage to reduce healthcare costs and strengthen quality of care. At an average cost of $30 per visit, compared to an average ED visit cost of $1,200 to $1,400 and urgent care costs of $150 to $200 per visit, such a model can deliver strong return on investment:
- One large Midwest health system with 35,000 covered lives decreased ED utilization from 242 visits per 1,000 associates to 192 visits per 1,000 associates.
- Another large health system with 65,000 covered lives decreased ED visits from 229 visits per 1,000 associates to 176 per 1,000 associates.
Moreover, a nurse-first triage line can provide a point of escalation for those with remote patient monitoring devices to help determine whether chronic conditions are escalating, steps to take in managing their condition, and when interventions, such as a face-to-face visit with their care specialist, are needed. It can also offer support for patients recently discharged from the hospital to help minimize readmissions, improving health outcomes while reducing costs.
Determining the right approach
How can employers select the right nurse advice line, including a nurse-first triage model, to deliver health education and support in the moment? Here are a few key considerations.
Ensure the line is staffed by a registered nurse. The first point of contact should be a registered nurse, not unlicensed staff who capture the patient’s information and leave a message for a nurse to return the call. Nurse-first models give employees assurance that they are receiving expert advice at the point of connection eliminating the risk of failed prioritization or delay or care.
Assess the partner’s familiarity with local resources. The right partner should be aware of local providers who are accepting new patients and community programs and services that can help meet the health needs of employees and their dependents. At Medical Mutual, one of Ohio’s largest health insurance companies, access to a 24/7 nurse-first triage line helped redirect half of callers who had intended to go to the ED during the first year of implementation, including to nearby providers who were accepting appointments. Over time, the plan’s ED avoidance rate is nearly 90%.
Choose a program that can be branded to your organization. This gives employees confidence that the resource has been vetted by your organization, increasing the potential for engagement.
By taking a new look at how to reduce unnecessary emergency care costs, employers can help employees and their families gain access to expert care advice more quickly, improving health outcomes and confidence in care decisions.
Dusti Browning, MSN, RN, NE-BC, is vice president of growth and client solutions at Conduit Health Partners.