Virtual triage for health plans: 9 benefits that redefine care

From operational efficiency to improving member engagement and retention, this virtual triage for health plans article outlines 9 game-changing benefits that health insurance companies worldwide are using to redefine healthcare.

What is virtual triage? Check out our guide to learn more.

Enhanced triage efficiency

We know that 74% of members don’t know the correct level of care for their needs. Using virtual triage, health plans can assess members' symptoms quickly, anywhere, anytime. It speeds up the triage process by evaluating members' needs and directing them to the appropriate care, services, or information that will set them on the right care path from the very onset of their symptoms—without the need for human intervention in the initial stage.

Rather than healthcare professionals spending valuable hours asking routine questions and performing basic triage protocols, AI-driven virtual triage can provide accurate guidance, helping free up time for medical professionals to focus on more tasks requiring specialized knowledge.

The information received in the symptom assessment is passed to the attending physician in a manner that suits, including integration with EHRs. This allows physicians to have all the information in front of them should an in-person or remote consultation be necessary.

As members complete the symptom assessment remotely, it reduces crowding in primary care and emergency settings, as well as reducing delays in care that can stem from members being unable to get appointments.

Virtual triage for increased member engagement

Virtual triage empowers members to take an active role in their health by allowing them to engage with their health insurer 24/7 from any location. Without the need to wait for office hours or appointments, healthcare services are available at members’ fingertips, allowing them to engage and keep engaging whenever they feel the need. This ability to consistently connect with their health plan allows members to build confidence and feel more in control about managing their health.

One study found that highly engaged members had 63% lower annual claims increases compared to less engaged members. In addition, engaged members were 34% more likely to use preventive services and 10% more likely to get immunizations.

By offering real-time feedback and guidance via virtual triage, health plans can engage their members without the need for additional physician hours. This ultimately provides the support members need without taking up appointment times and or unnecessarily exacerbating healthcare expenditure.

Scalability for health plans

Utilizing virtual triage, health plans can increase the number of members they can engage with at any one time—potentially assessing thousands of members simultaneously. Unlike in-person triage, virtual triage tools are not overwhelmed by sudden surges in demand, making them ideal for handling peak times, flu seasons, pandemics, etc.

This allows health plans to grow and enroll more members, without sacrificing member safety or satisfaction.

By streamlining the member journey, virtual triage assists health plans in making efficient use of resources, such as physician appointments or hospital beds. This frees up space for the most urgent cases to get the critical care they need in a timely manner.

Overall health system efficiency combined with the ability to be everywhere at any time is what makes virtual triage so beneficial to health plan scalability.

Improved member health outcomes

By providing members with timely access to healthcare information and services, virtual triage helps health plans reach their members early on and guide them to appropriate care settings. This type of early intervention (or support) can prevent low-acuity conditions from escalating to something more serious, as well as help to detect potentially life-threatening symptoms.

One study shows that 76% of members with symptoms of a heart attack did not plan to seek urgent care before checking their symptoms with virtual triage, while another suggests that in 2 of every 1000 triage interviews could result in life-saving decisions.

In addition, virtual triage can help health plans encourage the use of preventive services and vaccine programs. This ability to offer preventative care in addition to ‘sick care’ enables health plans to influence member behavior, encouraging and supporting them to be proactive in their health and potentially mitigating more complicated healthcare problems later on.

Cost savings for health plans

Virtual triage influences health plan spending in several ways. We’ve focused on three top factors—overuse of emergency departments, early detection of serious conditions, and automation of processes—although the complexity of the healthcare industry means there are many, many more that are difficult to quantify.

Overutilization of emergency departments and inappropriate use of healthcare services are major driving factors of unnecessary healthcare costs. The average cost of treating primary care conditions in an emergency department in the US is on average $530–2,032. In comparison, if that same member visits a primary care setting, it would cost, on average, $167.

Virtual triage reduces the misuse of high-acuity care settings and ensures members get the care they need without unnecessary spending—Infermedica’s symptom checker tool directed 85% of nib’s members to non-urgent care.

In addition to this, the sheer automation of the triage process itself is a huge savings point for health plans using virtual triage over in-person triage. In the US, Infermedica's virtual triage can save health plans up to $175 per interview conducted via a nurse triage advice line.

Find out how much virtual triage can save your health plan! Try our savings calculator!

Data-driven insights for health plans

Virtual triage solutions collect valuable, actionable data related to symptoms, demographics, and healthcare utilization, allowing health plans to gain a comprehensive overview of member behavior, population health, and emerging health trends.

Health plans can use this member-sourced data to fine-tune risk stratification for potential healthcare outbreaks or to determine the prevalence of certain diseases amongst distinct demographics or in specific regions. With the foresight of this data, healthcare insurers can develop targeted programs that include promoting preventative services and optimizing resource allocation to be better prepared for potential spikes or incremental rises in certain resource usage.

Data insights also help health plans identify gaps in care delivery or understand patterns in symptom reporting. Using this data, insurers can work to improve healthcare education or tailor services to specific segments of their member population to improve clinical outcomes and cost efficiency.

Improve member experience and retention

Many of the member advantages mentioned in points one, two, and four are driving factors in improving member experience and satisfaction—enhancing accessibility, encouraging members to be proactive in their health, assisting in navigation, offering healthcare education, delivering personalized healthcare journeys, and driving cost savings.

By building a relationship whereby members feel connected to their health plan and subsequently more in control of their health, insurance companies can build a more trusting two-way communication between themselves and members, helping to improve the member experience.

One research paper, published in PubMed Central, states, ‘delivery of earlier and faster, more acuity level-appropriate care, as well as patient avoidance of excess care acuity (and associated cost), offer promise as contributors to improved patient experience and satisfaction.’

Improving member experience and satisfaction has a knock-on effect on member retention. As the healthcare industry becomes more consumer-driven, satisfaction plays a major role in members’ decisions to stay with a health plan or not. One study shows that a good member experience is more important than pricing, with 52% of members who switched healthcare insurers citing poor experience as the primary reason.

Virtual triage improves in-network care continuity

Virtual triage acts as an expansion of a health plan’s current ecosystem. It allows members to engage with their insurer outside of traditional care settings and connect to services, such as telehealth platforms.

It gives health plans the opportunity to shape the member journey from the very beginning. Insurance companies can prioritize in-network care options, seamlessly navigating members from an initial virtual triage assessment to an in-network provider via their digital ecosystem.

Health plans can direct the healthcare journey from symptom to outcome, sharing data collected during the virtual triage assessment with in-network healthcare professionals. By keeping members within their healthcare sphere, insurers can improve continuity of care, with the potential to affect healthcare experiences and costs.

Virtual triage for better healthcare access

Improving access to healthcare is a major benefit of virtual triage technology. Regardless of location, time, or day of the week, members can access trusted healthcare information and carry out a preliminary assessment of their symptoms.

Infermedica's study with large Portuguese health insurer, Medis, showed that 20% of symptom assessments took place outside of physician operating hours. Of this 20%, virtual triage guided patients to a lower acuity care setting in 48% of cases.

Digital healthcare solutions also allow members to get peace of mind from their homes. For a person who is feeling unwell, the ability to gain accurate recommendations about their condition without the need to travel is invaluable. In addition, Infermedica’s virtual triage tool offers members educational articles about probable conditions and tips on the best self-care practices.

Virtual triage for health plans in a nutshell

Essentially, virtual triage is a way that health plans can extend their healthcare coverage beyond the four walls of traditional healthcare settings. It enables insurance companies to actively engage their members and encourage them to take an active role in their healthcare journey.

By promoting preventative services, health plans can attempt to tackle potential health risks. And by analyzing member data, they can be better prepared for possible outbreaks—allowing for better resource allocation, mitigating the possibility of resources becoming stretched, and improving health outcomes.

Thinking of investing in virtual triage? Check out these 8 questions to answer before investing in virtual triage.

Learn more about Infermedica Triage for health plans, or contact us to speak to one of our experts!