Advice Nurse Telephone Triage and Screening Program
- Participating Physician Groups (PPG)
- Los Angeles
- San Diego
- San Joaquin
The Health Net's Advice Nurse Telephone Triage & Screening program was developed to assist members in obtaining primary care. The Advice Nurse Telephone Triage & Screening program is a service offered in conjunction with the primary care physician (PCP) and does not replace the PCP's instruction, assessment and advice. According to community access-to-care standards, all PCPs must provide 24-hour telephone service for urgent/emergent instructions, medical condition assessment, and advice. The Health Net Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties) coordinates member access to the program, if necessary.
The program allows registered nurses (RNs) and other applicable licensed health care professionals to assess a member's medical condition and, through conversation with the caller, take further action, provide instructions on home and care techniques, and offer general health information. McKesson Health Solutions provides Advice Nurse Telephone Triage & Screening program activities for Health Net. Standard triage protocols are utilized, which have been written and reviewed by physicians.
Health Net ensures that telephone Advice Nurse Telephone Triage & Screening program services are provided in a timely manner appropriate for the member's condition, and the triage or screening wait time does not exceed 30 minutes. Information is available 24 hours a day.
Role of Medi-Cal Member Services Department
The Health Net Medi-Cal Member Services Department's 24-hour toll-free telephone number is printed on the back of the member's identification card. While assistance via the telephone is the PCP's responsibility, the Health Net Medi-Cal Member Services Department can assist members in reaching their PCPs when needed. The Health Net Medi-Cal Member Services representative can either get the member in contact with the PCP or, if the PCP is not available or at the request of the member, the call can be routed to the Health Net Nurse Advice Line.
If, for any reason, a member services representative experiences problems reaching a member's PCP, the call is routed to the Health Net Advice Nurse Telephone Triage nurse (or affiliated health plan in Los Angeles).
Role of the Program Nurse
On receipt of a call, the nurse addresses emergencies immediately by directing the member to a hospital emergency department and assisting the member in securing an ambulance, if necessary. Members who need urgent care are referred to an urgent care center if the PCP is not available. The referral record can be faxed to the emergency department or urgent care center to inform the facility of the member's condition and pending arrival.
The nurse educates the member on the role of the PCP, assists the member in scheduling an appointment with the PCP, and gives the member information on procedures to follow until they receive care from the PCP. A copy of the encounter is faxed to the PCP immediately after the call.
All interaction with hospital staff, urgent care center staff, and the PCP is documented. In addition, incidents reports are completed when a member does not accept the nurse's recommendations. The nurse uses a tracking mechanism to follow-up on the disposition of the member, as indicated, and notifies the PCP (and affiliated health plan in Los Angeles, if applicable) of any member who appears to require follow-up assistance with coordination of care