Technology Solutions to Lower Healthcare Costs for Insurance Companies

As we know, healthcare costs take a huge toll on the American health system. As reported by CMS, U.S. healthcare spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person. Providers aren’t the only professionals in the healthcare industry who can control healthcare costs. Health plans like yours can optimize their spending by adding services that decrease the use of more expensive, emergency use (ER) services. Read on to learn how health plan or insurance companies can lower their healthcare costs and increase efficiency by improving medical message intake, provide customized nurse triage solutions, and invest in remote patient monitoring.

Improve Nonclinical Staff Medical Message Intake

When patients call providers or health plans with concerns about their symptoms, their first points of contact are usually nonclinical phone operators, such as front desk receptionists. Because these operators aren’t certified medical professionals, they’re prone to overlook important details about patients’ symptoms that could indicate serious medical concerns. In fact, we’ve found that over 30% of patient phone calls do not relay sufficient medical information for providers to determine the emergency level of the call. This can lead to bigger issues including, but not limited to, increased medical malpractice risks.

For example, a patient might call to ask for a medication refill, and an operator may treat this as a straightforward, nonurgent request. But if that same patient is experiencing symptoms that are of concern — like a headache or numbness — and they fail to report them, the medical professional may think that this is a message that can wait for a response. That leaves the patient at risk for unnecessary morbidity or mortality if their symptoms are not addressed.

The best option to close this intake gap is by giving operators access to a real-time symptom analysis tool called MedMessage Assist (MMA). Developed by TriageLogic, this solution uses augmented intelligence to analyze the notes that operators type while they’re on the phone with patients. When MMA identifies symptoms or patient requests that could indicate more serious conditions, it prompts operators with additional follow-up questions. This information is then passed on to providers, who can get a holistic view of each patient’s needs and respond in the appropriate windows of time.

MMA has already demonstrated over 99 percent accuracy for medical message intake. Because these messages are complete, and providers are able to address calls appropriately, overall health outcomes improve. MMA can help lower healthcare costs for providers and emergency rooms and decrease health insurance claims.

Read more about MMA on our website.

Medical Call Centers and Outsourced Nurse Triage

When patients need after-hours health advice, a dedicated nurse line that’s available either through their provider or their health plan can make a world of difference. When patients call a nurse line, they will often speak with an RN from a medical call center that represents their plan, answers questions on its behalf, and advises patients on whether their symptoms warrant care. 

This kind of phone assistance is performed by triage nurses, who can evaluate patients’ symptoms and determine whether they can manage their care at home or should seek further medical care. Triage nurses use Schmitt-Thompson protocols to standardize how nurses perform these evaluations. They also document these patient interactions using sophisticated nurse triage software, which enables them to share information directly and confidentially with providers for continuity of care.

Having a nurse triage line that has robust data collection and insights can provide valuable information to insurance companies about the needs of their patient population, and helps them design proactive programs to decrease cost. Actually, we’ve found that nurse triage can both decrease morbidity and mortality rates, while also saving unnecessary ER visits. Nurse triage gives patients peace of mind by helping them learn what types of care are appropriate, how soon they should seek further medical care, and what services their plan covers.

If your health plan is unable to offer triage nurse lines internally, it can outsource it to a medical call center of triage nurses. TriageLogic’s Nurse Triage On Call is available 24 hours a day, staffed by certified triage nurses who are specially trained on medical phone etiquette and Schmitt-Thompson protocols. Nurse Triage On Call can be customized to fit your organization’s needs.

Remote Patient Monitoring

Remote patient monitoring (RPM) offers a means of early detection for potentially life-threatening conditions in patients battling chronic illness. It involves the use of remote sensors that connect to patients’ skin to measure important vitals like heart rate, temperature, and pulse ox, sending data to their providers for evaluation. In many cases, the large volume of data these sensors record can be reviewed by triage nurses, who then contact patients and providers when they identify concerns.

We’ve seen how remote patient monitoring can help providers and health plans improve patient care and health outcomes while increasing revenue, like managing patients with type 1 diabetes. RPM also improves the accuracy of patient vitals by recording this information automatically, decreasing the chance of human error with patients self-reporting. This can decrease unnecessary emergency interventions and save operating expenditures.

Health plans can reimburse providers who use RPM through contractual agreements similar to CMS. This strategy can lower health plan spending while radically improving patient care, when patients have immediate access to affordable care that will address their chronic conditions.

Questions About How Your Plan Can Lower Healthcare Costs?

If you represent a health plan and have questions about the services above, we want to hear from you! Contact us to learn how to reduce administrative costs and insurance claims with these health system solutions.