Listening to the Nurse Pays Off: An Integrated Nurse HealthLine Program Was Associated With Significant Cost Savings

Objective: To evaluate the impact of compliance with nurse recommendations about where to seek care on healthcare expenditures for a Nurse HealthLine (NHL) triage program.

Methods: Data from 53,206 adults with an AARP® Medicare Supplement Insurance plan insured by UnitedHealthcare who called into a NHL triage program were included. About 46 percent of the NHL calls involved triage where the nurse recommended a course of action. Callers following the nurse's recommendation regarding where to receive care (e.g., emergency room, urgent care, doctor's office, or home) were classified as adherent, while those who did not were classified as non-adherent. Program-related savings were estimated by comparing the difference in downstream healthcare expenditures between adherent and non-adherent callers after using multivariate modeling to adjust for case-mix differences between these groups.

Results: 55 percent of callers were adherent. Nurses were over three times as likely (41% versus 13%) to recommend seeking a higher level of care (e.g. emergency room versus urgent care), indicating that the program focused on directing members to the appropriate level of care for their individual circumstance. The program resulted in a total savings of $13.8 million dollars (p<0.05).

Conclusions: This study focuses on compliance to nurse recommendations for a NHL triage program designed solely for Medicare members with supplement (Medigap) coverage. The program was associated with significant savings, most of which were attributable to Medicare.