The State of the Union for Nurseline Services: Problems and Opportunities

In an ideal healthcare system, gaining immediate access to the right care in the right setting at the right time would be standard procedure. Unfortunately, because the current healthcare landscape is complex and fragmented, access to care is dysfunctional and costly. For example, 18 million avoidable hospital ER visits add $32 billion in costs to the healthcare system annually.1 Addressing this major issue requires rethinking legacy Nurseline services, a vital link in the healthcare continuum. 

Nurseline services today function as a 'check-the-box' system. Registered nurses triage symptoms, offer care advice, and refer callers to appropriate care levels. However, nurselines have remained largely unchanged for decades, causing glaring issues in their effectiveness as well as low utilization.

A key drawback is the impersonal and transactional nature of care provided by these services.  Once the call ends, members are left to navigate the next steps alone, often leading to a disjointed, inefficient, and frustrating healthcare journey. Outdated technology that is unable to efficiently manage high call volumes or effectively integrate with broader healthcare IT infrastructure further magnifies these weaknesses. The result: A poor member experience leads to increased frustration and, ironically, higher utilization of costly care settings like ER and urgent care for low-acuity cases with negative attribution to the plan. 

Transforming Nurselines (NALs) 

In an era of increasing member empowerment and digital connectivity, the need for a more seamless, proactive, and end-to-end healthcare experience is evident. A Digital Triage & Navigation Solution is the answer. Instead of merely serving as a gatekeeper and simply recommending a healthcare pathway to members, this Next Generation Nurseline delivers the services of an effective healthcare navigator. Digital Triage transforms Nurseline services into an active connector, facilitating real-time guidance with nurse-led engagement via members’ preferred communication channel – chat, text, phone, or video – while connecting the member to the most appropriate healthcare providers. This means not just advising a visit to the appropriate care specialist but actually facilitating that interaction within the same connected care experience. 

The integration of technology can significantly enable this transition. By leveraging AI and digital interfaces, the next generation Nurseline can offer a more personalized, efficient, and value-driven experience. This end-to-end guided care experience could have substantial impacts on healthcare outcomes, satisfaction, and cost savings by steering members toward the most suitable care and averting unnecessary urgent care or ER visits.

Seizing the Opportunity

The current Nurseline landscape is ripe for transformation. The status quo of offering stand-alone, reactive, and often disconnected care advice must give way to proactive, integrated, and personalized care navigation. By leveraging technology and member-centric strategies, Nurseline services can better align with the broader objectives of healthcare –  improving patient outcomes, increasing satisfaction, and ultimately driving down costs. The future is Digital Triage and Navigation: An always-on, personalized, trusted advisor that guides the member to the most appropriate care setting in a seamless fashion –  delivering value to both the member and the health plan. 

1 Avoidable ed visits - unitedhealth group. (n.d.-a). https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2019/UHG-Avoidable-ED-Visits.pdf