257215 Listening to the Nurse Pays Off: An Integrated Nurse HealthLine Program Was Associated With Significant Cost Savings

Tuesday, October 30, 2012

Jessica Navratil-Strawn, MS, MBA , Clinical Solutions, OptumHealth, Golden Valley, MN
Kevin Hawkins, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Timothy Wells, MPH, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Stephen Hartley, BS , Clinical Solutions, OptumHealth, Phoenix, AZ
Ronald J. Ozminkowski, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
HungChing Chan, MPH , Clinical Analytics, OptumHealth, Golden Valley, MN
Richard J. Migliori, MD , Health Services, UnitedHealth Group Alliances, Minnetonka, MN
Charlotte S. Yeh, MD , AARP Services Inc., Washington, DC
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.

Learning Areas:
Administer health education strategies, interventions and programs
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related research

Learning Objectives:
Describe a Nurse HealthLine (NHL) triage program for older adults with Medigap insurance. Explain analytical methods used to evaluate the program from a cost standpoint.

Keywords: Nurses, Telehealth

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Kevin R. Hawkins, Ph.D., Senior Research Director at OptumInsight, has over 20 years experience designing, conducting, and managing health services research. Dr. Hawkins has conducted a variety of research and evaluation projects, specifically health-economic, quality-of-life, disease burden, pharmacoeconomics and retrospective database analyses. Dr. Hawkins has authored over 40 peer-reviewed articles and presentations, and is a reviewer for several medical-scientific journals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.