More than 60 million Americans rely on Medicaid programs for their insurance coverage—and that number is projected to grow to 80 million by the year 2020 if all states embrace the enrollment expansion offered by the Affordable Care Act (ACA).
As the newly insured look at their options for healthcare, many will find that health centers provide convenient and reliable services.
To prepare for this influx of Medicaid patients, health centers have the opportunity to operate with a reimbursement designation of Federally Qualified Health Center (FQHC), qualifying them for grants under Section 330 of the Public Health Service Act. Nationally, these FQHCs receive 37.7% of their funding from Medicaid and 23.2% from federal grants, allowing over 1,100 FQHCs in the United States to provide care for more than 70 million patient appointments each year.
Health centers have been proven to successfully increase access to care, improving health outcome and containing healthcare costs. But as health centers look at the increasing number of patients who will seek care in the future, it's critical they look outside the walls of the clinic to ensure adequate patient access.
How Health Centers Are Using Telephone Nurse Triage to Coordinate Primary Care Services
As health centers look to provide primary care services to these new Medicaid patients, offering around-the-clock access to healthcare resources will be a critical—especially for health centers that are implementing the patient-centered medical home model of care.
To accommodate this requirement, many health centers have opted to provide access to a telephone based nurse advice line service, allowing patients to connect with the health center at anytime, day or night. These nurse advice services provide convenient support for patients while simultaneously enabling the health center to coordinate the delivery of appropriate care for the patient.
Below are four key ways that 24 hour Nurse Advice services support health centers.
#1) Provide Access to Care 24/7/365
Do your health center patients live in rural areas? Or do you have a presence in an urban community? In either case, patients may not have choices for after hours healthcare that are safe and convenient. A 24 hour Nurse Advice service provides patients with a convenient way to receive trusted health advice from the comfort of their home, and reduces the number of unnecessary visits to the Emergency Room.
In fact, our experience at SironaHealth shows that approximately 60% of Nurse Advice callers who indicated they were planning to visit an Emergency Room were advised by the RN to seek a lower level of care (see a Physician within 24 hours, see a Physician within 2 weeks, home care advice, etc.).
#2) Supplement and Support Your Clinical Resources
Clinical resources are always in short supply. It is essential to use Physician and Nurse Practitioner resources to provide in-person care and consult on emergent cases. Also, if 24 hour access is a requirement, clinical resources feel the strain of being on call and receiving non-emergency patient calls after hours. 24 hour Nurse Advice services provide patients with access to a Registered Nurse to ask health questions and have their health symptoms assessed. Emergent concerns can be escalated to an on-call provider, or the RN can direct the patient on the most appropriate level of care (see a Physician tomorrow; administer home care advice, etc.)
#3) Close Gaps in Care
A 24 Hour Nurse Advice service can be used as an effective way to convey health information to your patient population. Do you have specific patients that need to be reminded to schedule a mammogram or colon cancer screening? Would you like to issue a blanket health reminder to all patients over the age of 50, or to all parents with children under the age of 12? Patient specific rules and reminders should be incorporated into the Nurse Advice service, allowing your health center to capitalize on this valuable opt-in engagement point—ensuring patients are directed to the most appropriate level of care.
#4) Book Appointments for the Right Patients
As health centers begin to experience growth in their patient populations, it is essential to use appointment capacity effectively. Using physician authored clinical guidelines, your nurse advice line service is able to assess symptoms, answer health questions, and provide guidance on appropriate next steps. This ensures patients are only referred for appointments when it's clinically appropriate.
In the event the patient does need to be seen, they can either be scheduled directly by the RN or connected with the appropriate scheduling resource at the clinic.
The benefits described above are all provided as a natural extension of the health center’s operation. For the patient, the experience is seamless and convenient. The call data and results are provided electronically, to be incorporated into the patient’s health record.
As health centers look ahead to 2014, they will need to prepare for an increase in demand and volume. Looking outside the walls of the clinic to partners who are built to provide clinical services in a high volume environment is an effective way to add capacity and increase access, while still providing a seamless experience for the patient.