The Cost of a Triage Nurse Line:
An Overview for Health Plans, Providers, and Employers
According to a 2017 study by the Health Care Cost Institute, a visit to the emergency room can cost, on average, $1,3891 per patient. Many of these visits are unnecessary but patients aren’t always sure what constitutes an emergency or what alternative resources are available for them to use. In fact, we’ve found that on average up to 68%2 of people who call Health Dialog’s nurse line can be redirected to a less emergent level of care.
The cost-saving benefits of having a nurse line service is clear—helping patients better navigate the healthcare system can, in the long-run, reduce wasteful and unnecessary utilization. But how much does it cost to implement and run an effective 24/7 triage nurse line?
Nurse lines are more complex than typical call center operations because of the extra layers of security and medical experience required to appropriately help members (who may or may not be in crisis). Below is a list of key elements that must be taken into consideration when implementing and pricing a nurse line service:
- Salaries and Licensing: Nurse Lines require the staffing of experienced and knowledgeable registered nurses (RNs) who are licensed in all 50 states and able to work days, nights, and weekends (as appropriate). Additionally, these services require a variety of support staff in IT, quality assurance, security, legal, compliance, project management, training, accreditation, and RN resource management and scheduling.
- Quality Accreditations: Industry call center accreditations, such as those provided by URAC or NCQA, are designed to ensure high-quality standards in clinical excellence and customer service. These accreditations are critical but not easy to achieve. Understanding the ins-and-outs of building an accredited nurse line service will require specialized resources that can help an organization both develop but also implement the appropriate procedures and guidelines.
- Training: Updates to clinical guidelines, advances in technology, and changes to national and state-level laws and regulations can render existing programs obsolete without proper and timely training of both nurses and support staff. Other factors to consider include training staff in behavior change science methodologies, customer service, cultural sensitivity, patient education, and crisis management.
- IT Infrastructure, Software, and Security: Symptom check software, telephonic triage systems, workflow and reporting applications, as well as chat, email, and fulfillment functionality are just some of the IT requirements to run an effective nurse line. Additionally, back-end IT infrastructure to handle call volumes, PHI data management and encryption, and disaster recovery are all critical elements that reduce the risk of dropped calls, security breaches, or system issues that threaten business continuity.
- Translation Services: America is a melting pot of cultures and languages. No matter what part of the country your organization is in, whether urban or rural, you’ll likely have some patients in your population who are more comfortable with a language other than English. In fact, according to a 2015 study, there are over 63 million non-English speaking residents in the US3. Translation services are critical to helping these individuals bridge the gap to their care.
- Promotion: If you build it, will they come? Simply having a nurse line service won’t drive utilization, especially if members don’t know it exists or don’t understand the benefits. Targeted marketing campaigns that leverage simple, easy to understand, and highly persuasive messaging can increase awareness across the population. Targeted promotion also requires understanding the demographic and unique needs of each population to evaluate which messages, visuals, and marketing channels will work best.
If you plan to work with a nurse line provider, there are a few pricing methods you’ll come across—the one that’s right for each organization may depend on the following:
- The size of your population
- Historical utilization rates
- Whether you need a 24/7 service or just day or night/weekend services
- Level of promotion required to ensure usage
- The percent of people who don’t speak English
- What technology features (e.g., chat) are necessary
- What reporting packages are necessary to inform business objectives
- The overall goals of your program
Because of the highly-customized nature of a nurse line program, the cost can also be highly customized. However, there are three common pricing methods you’re likely to encounter:
- Per member, per month pricing (PMPM)
- Per call pricing
- Flat fee pricing
Each pricing structure has its own benefits, but the right option for your organization is highly dependent on the needs of your members. During pricing discussions, a nurse line service provider will evaluate your unique situation and suggest the most cost-effective option for your budget. To learn more about Health Dialog’s nurse line service and for a customized pricing quote, contact us at: https://www.healthdialog.com/contact-us
2 Health Dialog Book of Business Data, 2019