A large health plan built a 24/7 nurse advice line that went beyond symptom triage: follow-up calls, member services, data integration, and personalized care guidance. The result was 95% member satisfaction and a consistent 2:1–3:1 return on investment.
01
Enterprise-ready clinical access
Tailored 24/7 nurse triage expanded beyond basic coverage to deliver follow-ups, referrals, and member services.
02
Data-driven, safer decisions
Seamless technology integration enabled personalized guidance using real-time member health data.
03
Proven performance at scale
Maintained 95% member satisfaction while generating a 2:1–3:1 return on investment.
With millions of plan members worldwide, including employees, retirees, and families of all ages, a large healthcare organization needed more than a traditional nurse advice line. The goal was not only 24/7 triage coverage, but a more comprehensive, value-added solution.
The organization turned to Carenet Health to build a customized nurse advice line that extended beyond basic symptom triage to include follow-up support, member services, and seamless technology integration.
The result was a next-level clinical access model that strengthened member experience while delivering measurable financial performance. Health plans evaluating how nurse advice lines reduce costs while improving access can see the broader strategic case here.
The Medicare Advantage plan needed to improve Star ratings and HEDIS scores while delivering a member experience that fostered long-term loyalty and satisfaction. Serving millions of members across multiple states created increasing operational complexity, and fragmented engagement efforts were limiting performance.
The organization required a partner capable of unifying engagement programs and establishing a coordinated, enterprise-wide approach that strengthened relationships and improved overall engagement management.
Carenet built the solution on its 24/7 nurse advice line foundation, staffed by highly experienced registered nurses providing around-the-clock triage, treatment advice, and care setting recommendations via phone, portal chat, and email.
Follow-up calls
Within 72 hours, RNs attempted three follow-up calls to all 911 and ER dispositions to ensure appropriate care, re-triage if necessary, and offer case or disease management referrals.
02
Member services support
Assisted members with provider searches, pharmacy contacts, and incentive program enrollment, while seamlessly transferring to other departments as needed.
03
Care advice delivery
Sent secure, personalized care guidance to members via the plan’s web portal.
04
Program referrals
Provided clinically appropriate referrals during both inbound and follow-up calls.
By integrating directly with the plan’s proprietary technology, Carenet nurses accessed relevant member health information including medication records, health assessments, and prior visits, allowing them to deliver personalized, efficient, and safe care. For health plans focused on reducing ER utilization costs, see how a similar program delivered $5.3M in savings.
The program strengthened member experience while delivering measurable financial return year after year.
How Carenet built the 72-hour follow-up protocol, integrated with proprietary technology, and delivered year-over-year results across millions of members—it is all in the downloadable case study.
