Once populations are targeted for support and intervention via our Poindexter advanced and predictive analytics (via current state and predicted risk factors), we’ve found that one of the most effective ways to support targeted employees and members is through live or telephonic nurse influence and intervention.
The right nurses who are skilled in influence and rapport-building are able to successfully “take the final mile” for those with chronic conditions and co-morbidities, inappropriate ER utilization, gaps in care, medication risks, potential pain medication issues, and predicted events such as hospital admissions, re-admissions, heart attacks, strokes and more.
They are able to deliver individuals the education and support they need to make important lifestyle and preventative care changes. This is one of the most effective programs that we’ve seen in delivering needed outcomes.
Nurses are able to help individuals better understand their conditions and co-morbidities, interpret their doctor’s instructions and treatment plans, navigate between primary care and specialists, and get needed preventive health testing and immunizations as well as care for specific health conditions. Additionally, they are adept at supporting individuals who need lifestyle modification in areas as managing stress, nutrition, activity, sleep and rest, life balance, tobacco cessation and goal setting.
Hypertension Intervention and Influence Study Findings
This type of intervention and influence really does make a difference. According to a recent study that was presented at the American Heart Association’s Joint Hypertension 2018 Scientific Sessions, “Lifestyle modifications, including healthier eating and regular exercise, can greatly decrease the number of patients who need blood pressure-lowering medicine”.
Study participants were overweight or obese, but were not taking blood pressure medication at the time of the study. Groups were randomly assigned one type of intervention. One group started the DASH diet, joined counseling, and completed supervised exercise three times per week. Another group only changed to the DASH diet. Another group changed nothing.
Participants in the first group had the most success overall with lowering their blood pressure, losing an average of 19 pounds over 16 weeks and reducing their blood pressure readings by an average of 16 millimeters of mercury (mm Hg) systolic and 10 mm Hg diastolic. Those in group two showed a blood pressure decrease of 11 mm Hg systolic and 8 mm Hg diastolic. Those in group three (who changed nothing) averaged a blood pressure decrease of 3 mm Hg systolic and 4 mm Hg diastolic.
Other Areas Nurses Can Impact
Nurse Navigators are adept at directing individuals to Plan, provider, employer, local and community resources for needed support. This can positively impact overall health and wellness as well as overcome barriers due to social determinants of health.
Our clients’ nurse navigators are often called upon to coordinate with the client and insurer on large case management after the identification of those who are slipping through the cracks. They can support utilization management, case management, disease and chronic condition management, medication adherence and risk reduction and much more.
We’ve seen that successful Nurse Navigation programs individualize outreach and support to each member in a way that best fits their situation, medical history, lifestyle and culture. Nurses are trusted clinical resources, who are able to utilize a caring and empathetic approach to drive strong results and member satisfaction.
For our clients, Nurse Navigation outreach doesn’t begin before there is research and analysis of each targeted member via the longitudinal member profile in Poindexter. This comprehensive member view incorporates multiple years of claims history (medical, pharma, vision, dental), predictive risk scores and risk drivers, care gaps, medication compliance and risk, provider details and much more. Once the profile is fully analyzed and the opportunities are identified, individualized action plans may be developed to enhance quality, cost and member experience. They are then able to record outreach and other details within the HealthNotes clinical workflow portion of Poindexter.
Results Delivered – and Clearly Measured
Members identified for outreach and support programs are stratified within Poindexter so that program and individual results may be systematically tracked across many factors via the Initiative Tracker functionality. This delivers powerful visibility into utilization and cost across medical and pharmacy within the target groups before and after a program starts.
For one client, Nurse Navigators focused on key goals such as hypertension, diabetes, high cholesterol and annual blood work. They were able to exceed client goals in nearly every area of focus.
|Measurement||Metric Calculation||Actual Outcome||Results|
|Hypertension||75% of identified members will have BP taken and recorded monthly||98%||Exceeded Goal|
|Hypertension||85% of identified members will comply with filling HBP medications as ordered||82%||Nearly Met Goal|
|Hypertension||75% of identified members will have annual visit to manage this condition||87%||Exceeded Goal|
|Diabetes||75% of identified members will have annual visit to manage this condition||90%||Exceeded Goal|
|Diabetes||75% of identified members will show improved A1c or maintain A1c ≤7 measured at appropriate time interval twice annually for those at glycemic goal, quarterly for those not||87%||Exceeded Goal|
|High Cholesterol||85% of identified members will comply with filling statin meds as ordered||84%||Nearly Met Goal|
|High Cholesterol||75% of identified members to have annual visit to manage this condition||93%||Exceeded Goal|
|High Cholesterol||60% of identified members to show improvement with their LDL or maintain LDL ≤100 measured at appropriate time interval||67%||Exceeded Goal|
|Annual Appropriate Blood Work||75% of identified members will have appropriate blood work for chronic health condition at leas annually||92%||Exceeded Goal|
If you’re interested in learning more about how Nurse Navigator programs are being planned, launched and run across our client base, or how our Poindexter analytics platform identifies targets and measures results across client programs, please contact us here.