Essential Insights
- 24/7 access improves decisions: Members receive real-time clinical guidance, helping them choose the right level of care and avoid unnecessary ER visits.
- Upfront triage reduces waste : RNs triaged 700+ conditions, escalating only appropriate cases to physicians.
- Better decisions drive savings: The program delivered $176 per interaction savings, $12M in annual cost reduction, and a 3:1 ROI.
The Big Picture
Health Care Service Corporation (HCSC) needed to improve how members accessed care while reducing unnecessary ER visits and overall medical spend.
To address both access and cost, HCSC partnered with Carenet Health to implement a 24/7 Nurse Line, giving members direct access to registered nurses for symptom assessment, guidance, and direction to the most appropriate level of care.
The program delivered measurable impact, averaging $176 in savings per interaction, generating $12 million in annual savings, and achieving a 3:1 ROI.
Challenge
Unnecessary emergency room visits were driving up costs for HCSC, putting pressure on both medical spend and overall performance.
Members weren’t sure where to go for care or how urgent their situation was. Without clear guidance, they often defaulted to higher-cost options, even when their needs could have been addressed more appropriately elsewhere.
At the same time, HCSC needed to maintain high-quality member experience. Reducing utilization alone wasn’t enough. Members still expected easy, reliable access to care and reassurance that they were making the right decision.
This created a difficult balance: how to give members immediate access to clinical support while also guiding them to the most appropriate, cost-effective level of care.
HCSC leaders needed a solution that could improve how members navigate care in real time while reducing avoidable utilization.
Key Challenges Sidebar
- Challenge 1: Rising unnecessary ER utilization
- Challenge 2: Increasing avoidable medical spend
- Challenge 3: Maintaining high member satisfaction
- Challenge 4: Need for 24/7 access to care
Solution
Click or tap here to enter text. HCSC partnered with Carenet Health to implement a 24/7 Nurse Line, giving members immediate access to registered nurses who could assess symptoms and guide them to the right next step.
When members reached out, nurses served as the first point of contact, asking the right questions and using evidence-based protocols to evaluate more than 700 adult and pediatric conditions. Each interaction focused on helping members understand what was happening and what they should do next.
Only when clinically appropriate were members escalated to an on-demand physician. In many cases, nurses were able to provide care guidance, at-home treatment recommendations, or direction to a lower-cost care setting, preventing unnecessary escalation.
The experience was designed to be simple and consistent. Members had a single point of access for both nursing advice and virtual physician care, with clear guidance delivered in real time.
Behind the scenes, Carenet integrated with HCSC’s systems, implemented customized training aligned to the plan’s needs, and maintained continuous quality monitoring to ensure a high standard of care.
The result was a model that helped members make better decisions in the moment, improving care direction while reducing avoidable utilization.
Results
HCSC delivered meaningful improvements across cost, experience, and care outcomes:
- 96% member satisfaction, reflecting an improved care experience
- 58% of members who planned to visit the ED were redirected to a lower level of care
- 69% of all symptomatic callers were guided to a more appropriate care setting
The financial impact was significant:
- $176 in care-avoidance savings per triage interaction
- $12 million in annual cost savings
- 3:1 return on investment
Beyond the numbers, the program changed how members engaged with care:
- Members received immediate, trusted guidance instead of guessing where to go
- Clinical decisions were made earlier, preventing unnecessary escalation
- The plan gained more control over how care was accessed and delivered
What Members Experienced
“The nurse was excellent—very helpful and kind. They explained everything clearly, and I highly recommend this service.”
— Member Feedback
- “Tht better prepared to handle their healthcare situation
- 94% would recommend the service to a friend
- A 92 Net Promoter Score (NPS) across more than 4,300 surveys
- These results highlight a consistent ability to deliver not just cost savings, but a high-quality, trusted member experience at scale.
The nurse I spoke to was helpful. Made me feel better prepared to treat my injury.”
— Member Feedback
Consistent Experience at Scale
While these results were achieved with a single health plan, they reflect the broader experience members have across Carenet’s Nurse Advice Line programs.
Across Carenet’s NL:
- 97% satisfaction with nurse interactions
- 92% of members fel
