Four Elements of an Impactful Nurse Line Program
“I have asthma and I’m having trouble breathing. It’s 1AM. What should I do?”
“My infant has a fever of 102. Do we need to go to the emergency room?”
“I’m having pain in my hip and I’m not sure why.”
Every day, our nurse health coaches receive calls like these from members with urgent health concerns. In these instances, a nurse line program becomes an extension of the member’s pediatrician, primary care physician, nurse, or other trusted health professional. The program must be one that members can trust to be there — even in the middle of the night — to guide them to the best care option available and help them avoid costly, and typically, unnecessary emergency room visits. What is the core of good nurse line program made of? Through our years of experience, Health Dialog has found that an effective program has a foundation made of up these components:
- Symptom assessment and triage services
- Urgent and non-urgent care advice
- Health and wellness education and resources
- Referrals to additional professionals or services
- Daily and monthly reporting
- Proven operational standards and measurement
- NCQA certification
For health plans that have a nurse line simply to satisfy the basic NCQA requirements, a check-the-box program may be all that is needed. But—plans wanting to truly impact their population’s health and wellness beyond the basics, must deliver a more robust offering with a strong foundation and additional smart features. Here are four competencies to look for when choosing a nurse line vendor that will contribute more to your organization’s broader population health efforts:
- Effectiveness and Efficiency: Nurse line health coaches should be able to quickly and efficiently assess the callers’ needs and accurately direct members to the appropriate level of care or benefit resource. Live access to a person and seamless integration with health plan, provider, and community resources is essential for appropriate care direction and member satisfaction.
- Staff Experience: Many nurse line programs require health coaches to assess the member’s symptoms using a systematic series of questions, which according to the member’s responses, queue up appropriate treatment outcomes. While these tools are useful in saving time and focusing on the caller’s particular issue, they are not designed to replace clinical judgment. Programs administered by experienced nurses or healthcare professionals utilize the additional clinical skills and knowledge necessary to further assess the urgency and severity of a caller’s symptoms and provide personalized support when necessary.
- Proven Quality of Care: Nurse line programs should be primarily equipped to offer guidance and information to members making urgent care decisions. However, an important aspect of the program should be the ability to educate patients on self-care and healthier lifestyle choices to promote sustained behavior change, ongoing wellness, and ultimately more appropriate use of healthcare resources in the future.
- Multicultural Expertise: Diverse populations require a nurse line with multi-lingual health coaches and/ or live interpretation services. An additional component, that is arguably just as important, is expertise in cultural sensitivity. Understanding social and cultural factors is critical for effective healthcare guidance.
Health Dialog’s comprehensive 24/7 Nurse Line support is available as part of our Chronic Care Management program or as scalable wraparound or after hours service to enhance a plan’s existing program.
We'd like the opportunity to help you manage your member population. Click here to contact us today.