Achieving Dramatic Healthcare Savings With a 140-Year-Old Innovation: The Telephone

There are a wide range of communications tools available to connect with patients and collect vital data about their health. But in the world of telehealth, the ability to speak with an experienced clinician via the telephone (whether landline or cell) remains a convenient, cost-effective, and personal tool.

Picking up the phone to talk to a knowledgeable nurse is much faster than going online for a chat. Also, vital information can be conveyed over the phone that online encounters can easily miss. On a telephone call, nurses can gather clues about a patient’s situation based on his or her tone of voice and small nuances that are discernable only in a live conversation. Patients also can gain reassurance when they hear the nurse’s voice offering specific instructions in a calm and compassionate voice.

The reality is that communication through most nurse advice programs ends up being conducted by phone anyway. People see a phone call as the fastest way to address their urgent concerns—for example, a parent frightened by an infant’s high fever or someone who suspects his or her spouse is exhibiting stroke symptoms.

As healthcare providers take on financial risk for managing patient populations, nurse telephone triage programs offer a proven way to keep costs under control by directing patients away from unnecessary and expensive visits to the emergency department (ED) and urgent care.

Used for decades by health plans and government payers, the best nurse advice programs generate ROIs of 2:1 or higher, according to AxisPoint Health’s business data. By helping callers identify the most appropriate care setting, telephonic nurses can achieve an 82 percent ED redirection rate, keeping the great majority of patients who would have gone to the hospital for a nonemergency out of the ED.

The Clinical Return

In addition to cost savings, nurse advice programs offer healthcare providers extra clinical support at a time when many organizations are facing physician and nurse shortages. Because the programs operate 24/7/365, telephonic nurses can provide wraparound services to physician practices, hospitals, and other providers after hours, on weekends, and on holidays.  

In between responding to patients with acute problems like shortness of breath, telephonic nurses can help manage patients with chronic conditions. For example, when heart failure patients are discharged from the hospital, they might be instructed to call the nurse advice line after hours with concerns and questions. 

Physicians naturally will want to have confidence in any service they recommend to their patients. The recommendations provided to patients through such services therefore should be based on current, evidence-based guidelines approved by respected medical associations, such as the American Academy of Family Physicians and National Institutes of Health. These guidelines can be incorporated into computerized algorithms that allow the RNs to quickly and appropriately assess a patient’s symptoms.

Nurses always should be prepared to should advise patients to seek emergency care immediately, when warranted. For nonemergency situations, the nurse typically will recommend specific self-care actions or advise the patient to follow up with his or her primary care physician.

A specific—and valid—concern about nurse advice programs that has been raised by physicians is that the availability of such programs could stand in the way of patients to taking steps to obtain necessary emergency or follow-up care. The best way to address this concern is to ensure the help line is staffed with experienced RNs who adhere closely to evidence-based recommendations (which should be reviewed and updated regularly) and who will always be prepared to strongly urge patients to seek follow-up care when the situation calls for it. Indeed, data show that patients who receive such directives tend to follow through. The recommendations provided by a nurse advice line should be fully and demonstrably in alignment with the advice the patient would receive from his or her primary care physician or from an on-call physician in an emergency department.

The Financial Return

By successfully directing patients to the most clinically appropriate setting—and circumventing unnecessary ED and urgent care visits—nurse advice programs can generate positive ROIs for providers of all sizes. One key is raising awareness of the program among patients who have a history of high ED usage or who are likely to use emergency or urgent care services due to a clinical condition, socioeconomic status, or other circumstance. AxisPoint Health internal studies have found that four times as many calls are received by our nurse advice line when clients promote awareness of the nurse advice line service among their patients. With the higher call volume, the nurse line has more opportunity to engage with callers and direct them to the right level and setting of care.

A nurse advice program equipped with advanced data analytics also can assist their organizations in identifying high-risk patients. These patients can then receive reminders to use the triage line via promotions and educational materials and through their primary care providers.

Another challenge for risk-bearing health systems is keeping patients in-network. Nurse advice programs can assist with this task by directing callers to health system’s EDs, hospitals, physicians, and other providers. However, the telephonic nurses will require ready access to patients’ insurance eligibility information and be fully informed about the availability of in-network providers.

In an exemplary nurse advice line, the emphasis is on caring and compassionate customer service, and the personal nature of such a program is likely to result in a high caller satisfaction rate.

Sometimes old innovations are still the best innovations.  

Mary Jane Konstantin, RN, is senior vice president and general manager of CarePoint at AxisPoint Health, Westminster, Colo.