Close

May 11, 2021

The Evolving Role of Nursing for Cost Containment in Healthcare

Nursing and Cost Containment in Healthcare Image

It surprises people to learn that Roundstone employs two registered nurses as an integral part of the CSI Team – our data analytics and insights service for cost containment for healthcare. They help our customers run their health plans more effectively.

When it comes to making decisions involving a patient’s experience, we know just how important it is to have a medical expert in the room who is also familiar with patient care. The nurses emphasize proactivity and proper utilization of plan services, which helps to contain costs while also promoting better outcomes.

Brooke Piguet, RN, and Gordana Cecez, RN have been members of Roundstone’s Cost Containment CSI Team for almost ten years between them, and combined have nearly twenty years of nursing experience. They bring a critical eye to the recommendations made by the CSI Team to ensure that solutions are medically appropriate and in patients’ best interests, as well as effective cost-saving options for employers.

We sat down with Brooke to talk about how her experience informs her perspective on cost containment for healthcare and the patient experience.

Q: How does your role Impact Cost Containment in Healthcare?

A: We provide all-around clinical support and can answer any medical question. Gordana and I have worked with a large realm of demographics and communities so we have a solid understanding of medical effectiveness and can apply this knowledge to any case to deploy effective cost containment for healthcare strategies.

I’ve been a nurse since 2010, and have worked in mostly Emergency/Trauma care, with a sub-background in geriatric care and orthopedic surgery. My background in Emergency/Trauma care gives me experience with an extremely large range of patient diagnosis and emergent situations that would possibly drive high-cost claims.

Gordana has been a nurse since 2013, and has experience in post-trauma care, colorectal unit, hospice and home care. Her background gives her the knowledge to understand a patient’s needs post hospitalization and ongoing cost.

We both have experience from beginning of life to end of life, and everything in between. The two of us make an excellent team bouncing different experiences off each other to help us make the best cost savings decisions together.

Q: How does your nursing experience inform your perspective on new solutions?

A: When we look at an issue, we look at the whole patient and not just the dollar amount. The goal of cost containment in healthcare is to direct cost savings without interrupting patient care.

For example, infusion drug costs are much higher at a hospital compared to an infusion center. You will always get more ideas and a better solution when you consider the patent experience as well as how to protect the employer.

And we always try to find cost savings that are really cost savings. At times we come up against patient demographics being in rural areas. We always try to find cost containment solutions for healthcare that won’t interrupt a patient’s care or cause severe inconvenience. Dollars can’t get in the way of someone feeling comfortable in their healthcare, and a four-hour drive to an infusion center or outpatient setting isn’t necessarily going to be in the patient’s best interest. So we look at all kinds of alternate solutions in a case like that, like in-home care.

Q: What do you think of telemedicine? How is it being used now, and how could future applications transform patient care?

A: Telemedicine is great for follow-up care – and effective for cost containment in healthcare. There are advantages to being able to check in remotely. Pre-visit consults are also a good fit for telemedicine because you can already be established with a physician before you go in. These services also give physicians more avenues of care because they know you.

I was taught that in-person assessment, hearing and seeing a patient is the best way to determine what is going on with a person. Telemedicine can get in the way of that and should not be used as a substitute for the traditional face-to-face doctor-patient visit and relationship. Can it help in a quick situation? Absolutely. Sinus infection, a rash, mental health, cold and flu– some things can certainly be done through telemedicine. And it’s good not to take a sick person out of their homes to expose their illness.

For example, when it comes to women’s health, you can’t do a pap smear using telemedicine. Or diagnosis a UTI over the phone. Some things you definitely want to have checked out in-person. I worry about the potential for a disconnect in finding underlying conditions when a patient isn’t in the same room as their doctor. With that being said, I hope that patients with chronic conditions like high blood pressure and diabetes get back to seeing their providers in-person now that we know more about how to take proper precautions for COVID-19. We can’t let telemedicine be the lazy button.

Brooke Piguet, Nurse and Cost Containment in Healthcare Expert Graphic

Q: Can you share a moment where you felt you made a big difference for a member or client?

A: Not too long ago, there was a patient who needed a drug infusion and we worked very closely with our CSI team on a cost containment plan for her healthcare which relied on home infusion instead of going to the hospital. The patient loved it. We made a real difference to their quality of life, and we saved the company a ton of money. A real win-win! I think about her situation at times, when thinking if home infusion is the right fit for a member.

Q: What do you think is missing from the communication between insurers and members that hurts cost containment for healthcare?

A: The one thing that I think gets lost is, “How do these changes affect me and my family?” Often, employers don’t provide enough information about the plans and how to use them effectively – from on-going wellness programs to more catastrophic diagnoses like cancer. Insurance can seem complicated. People in general just want to know they’ll be taken care of.

I think that transparency can get lost between insurers and members, too, and forthcoming cost transparency legislation is going to be huge. You have very knowledgeable adults with health coverage who don’t understand it. I am guilty of that myself, until I started working in the industry.

Q: So how can we be smarter consumers of healthcare?

A: My number one tenet for cost containment in healthcare: Stop going to the ER for non-emergency issues! Especially while doctors’ offices are open. It’s very expensive, you have a greater risk of viral exposure, and you’re not going to be any better off because of it – plus you may be making it harder for the ER to serve people that are truly in need of urgent care.

In general though, I am all about people taking personal responsibility to understand their healthcare benefits. My advice to members is to ask for someone to talk to you about your plan. If you have a new benefits plan or a new job, make sure your current care isn’t interrupted with any of the specialists you see. This is really twofold: employers and their HR departments need to feel comfortable having these conversations and educating employees.

Focus on employee education and engagement. Build a great onboarding program. Design cool flyers and place then around the office where people congregate, and include in your regular cadence of internal communications to educate and inform members. Give multiple points of contact and resource centers. When you give people resources, they have more personal responsibility (and they can’t say they didn’t know).

Employees on your health plan should know, at the very least:

  • Who is my network provider? and
  • Who can I contact if I have questions?

These are simple tools to help people be accountable for their own healthcare. And we know that employers who do engage employees save money down the road by investing in employees’ health. That usually results in healthier, happier and more productive employees.

Q: Can you give an example of how working with a concierge service can help patients?

A: Concierge services are effective strategies for cost containment in healthcare. They are so nice because they offer opportunities to give someone a call, tell them what you’re looking for, and they provide options near you, that are rated well, and cost-effective.

These programs can help when you have ongoing medical issues. For example, say you’ve just been discharged from the ER with a non life-threatening diagnosis, and you need to follow up with a GP. You have to find one if you don’t have one. Or when your doctor refers you to a specialist, but they are an hour’s drive away. Concierge services can help with all of this.

Also many people don’t know that you can call and ask about high-rated doctors. Maybe you have cancer and you don’t like your doctor or the nurses you’ve encountered. A concierge service can help find a second opinion that might make a patient feel more taken care of.

People should know they have options, and they should know that everything to do with their care–medical records, treatment plans, prescriptions– is transferrable. Plus, your employer pays for this- use it! I just believe people should feel empowered in their health care decisions. It is the flip side of cost containment in healthcare.

Hear more from Brooke at the Virtual Medical Captive Forum

We appreciate Brooke, Gordana, and nurses everywhere for the human touch they give to patient care. We were fortunate to have Brooke join us as an expert panelist on the Managing Catastrophic Diagnoses session of our recent virtual Medical Captive Forum. This was one of many great topics on cost containment for healthcare – a theme of the virtual conference.

Watch her session on demand now (and gain access to all other sessions too!)