Clinical Activation

Access to Registered Nurses (RNs) for Virtual Clinic, 24x7x365 triage, decision-support, coaching and care management

Our clinical team of telehealth trained Registered Nurses (RNs) are front and center in these solutions delivering expert clinical support with 24x7x365 triage, virtual clinic access, site and course of care guidance, shared decision-making, coaching and care management.

Our main offerings within Clinical Activation are:

24×7 Virtual Clinic

Our Virtual Clinic is the only telehealth model that seamlessly combines the traditionally separated nurse advice / nurse triage line with virtual physicians and behavioral health specialists. We provide registered nurses up-front in the telehealth process to triage symptoms 24x7x365. They are able to answer questions, assess symptoms (using proven clinical guidelines) and guide members on site and course of care.

Although more than 46% of our Virtual Clinic Nurse Advice Line calls are solved with at-home treatment, some situations require physician or behavioral health guidance. By connecting members with a nurse before making this physician referral, we add another layer of safety, and cost savings via rapid triage and direction to the most appropriate site of care – including connections to our virtual physicians and behavioral health specialists and clients’ preferred retail clinics and primary care and other providers.

24×7 Nurse Advice Line

Having an experienced, compassionate nurse available anytime to answer questions, assess symptoms (using proven clinical guidelines), and provide site and course of care recommendations — results in educated healthcare decision-making. Staffed by highly skilled RNs, our Nurse Triage team is available 24×7 to assist with callers’ health concerns — whether it’s a twisted ankle, high fever, drug reaction or chest pain. More than 46% of our Virtual Clinic Nurse Advice Line calls are solved with at-home treatment.

We bring nearly 30 years of experience in providing consumers easy access to the right information on the right site of care at the right time. Our RNs are a trusted resource to triage members’ symptoms, and to offer expert guidance. This reduces costs and delivers better outcomes across the board – particularly in reducing inappropriate ER utilization. We offer a nurse first model where our RNs are the first to answer inquiries, as well as a call-back model where our Member Services team answers inquiries and prioritizes and routes them based on individuals’ needs.

Carenet’s Nurse Advice program is also a valuable engagement and motivation tool to help promote health-management programs and enlist members into additional programs and services that support a healthy lifestyle.

Learn more about Nurse Advice Line best practices via our e-book.

Clinical Decision Support / Shared Decision-Making

Using evidence-based decision aids, our experienced registered nurses collect and analyze critical data enabling them to conduct personalized, in-depth consultations in support of even the most complex healthcare decisions (surgery, advanced imaging, tests, procedures, discharge planning, etc). They thoroughly explain symptoms, exams, tests, procedures, treatment options and condition management. By combining the latest medical information with their years of clinical experience, our nurses educate members and prepare them to effectively communicate with their physicians regarding treatment options.

The comprehensive, impartial feedback our nurses provide empowers consumers to make more informed decisions with their physician and family.

Coaching and Care Management

Our Coaching and Care Management Solution combines the components of coaching and care management in a framework that allows each healthcare consumer to receive direction from their own expert resource to empower them to confidently make better health decisions. These expert resources build rapport and relationships so that they can guide, educate and influence the people they support in an individualized way.

Our model includes coaching, active listening and motivational interviewing skills, as well as clinical assessments, transparency support, care coordination and shared care planning. Our process helps people to improve self-management behaviors that protect and promote health, monitor and manage symptoms and signs of illness, manage the impact on health, and adhere to medication and treatment regimens.

We go beyond simply working with a consumer to help them to adopt healthy behaviors and reduce overall health risk, we improve partnerships between consumers and their healthcare providers. The collaborative consumer, provider, care advisor partnership creates a powerful means to identify problems, and better target interventions. These interventions are more effective because they are reinforced by everyone, and they enhance the consumer’s ability to successfully implement the shared care plan. Through our personalized and educational approach, we support sustained behavior change, and also allow consumers to adopt new perspectives and skills that can be applied to additional health issues as they arise. Clinical Activation was built to cover many areas of market need where clients are facing high costs, high risks, and issues with member and patient satisfaction.

We are making measurable impacts for our clients in areas such as:

  • High risk/high cost members
  • Potentially preventable admissions and readmissions
  • Inappropriate visits to the ER or Urgent care
  • Closing gaps in care for HEDIS, Star Ratings and MACRA
  • Health Risk Assessment Support
  • Medication adherence
  • And more…

We are able to proactively work with our clients to identify the areas where we can have the most impact to meet their unique clinical program needs.

We are able to execute single point of contact outreach programs to handle high pain point areas such as chronic condition and case management – and we also offer year-round, multi-touch, multi-channel programs as well where we receive interactions as well as outreach to identified groups of consumers who need clinical support.

Our 24x7x365 availability and our proven people, processes and technologies give us the ability to implement solutions quickly and flexibly for our clients. This is highly valued by our clients who are implementing pilot projects as well as long-term programs.

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