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At ProgenyHealth, NICU means Neonatal Intensive Collaboration Unit!

May 2016 Blog, Health Management, Stories from the NICU Comments Off on At ProgenyHealth, NICU means Neonatal Intensive Collaboration Unit!

What is collaboration? Wikipedia defines it as the process of two or more people or organizations working together to realize shared goals. Central to successful collaboration is identification of a common purpose, the shared goal that everyone on the team is working towards.

At ProgenyHealth our mission clearly defines that common purpose:

With passion and a singular focus, we improve the health outcomes of premature and medically complex newborns through provider collaboration and parental engagement.

From the moment a newborn is referred to ProgenyHealth, the family is surrounded by dedicated health care professionals whose focus is supporting them through this difficult time while maximizing their newborn’s health outcomes. This is accomplished through directing the efficient use of clinical resources in a manner that promotes quality health care.

Staff within ProgenyHealth’s Utilization Management (UM) Program speak directly with the hospital to coordinate and monitor the appropriateness, cost effectiveness, and efficiency of care being rendered. Our Case Management (CM) staff develops a timely plan of care and empowers families to take control of their newborn’s health care needs. No one member of the team is more important than another – all must work in concert to achieve the mutually beneficial outcome.

Let’s take a look at what can happen when a managed care organization, provider network, vendor, and caregiver all work together toward a common goal:

ProgenyHealth managed a full term baby girl who developed breathing difficulties immediately following her birth. Studies revealed that she had a congenital heart defect necessitating surgery. Following surgery, this baby had difficulty feeding and gaining weight, so a gastrostomy tube (G-tube) was placed. After spending 25 days in the NICU, this baby girl was discharged to home on several medications.

While completing the initial needs assessment with the baby’s mother, the case manager made sure that the mother had an adequate supply of medication and syringes, understood the rationale for administering each medication and the associated side effects, and that she felt comfortable giving these medications to her daughter. The case manager also reviewed the signs and symptoms of cardiac and respiratory distress, what to do in case of emergency, and the importance of keeping the follow-up appointments with the specialists. The mother shared that she had applied for a State waiver to provide supplemental health insurance due to her daughter’s medical conditions.

A week later the case manager called the mother to check in and review the baby’s plan of care. It was during this call that the mother requested assistance with the compounding fee of $20 per month per medication that she was being charged to ensure that three of the medications could be made compatible for administration via the G-tube. Financially this was causing a burden for the family while they awaited approval of the waiver for which they had applied.

The ProgenyHealth Case Manager contacted a supervisor at the health plan through which this baby had insurance, and together they identified an in-network pharmacy that would not charge a compounding fee and offered both delivery and mail order options. The case manager contacted the pharmacy and the mother, and the prescriptions were transferred to the new pharmacy. With this burden lifted, the mother was able to concentrate on her daughter’s care.

This case example illustrates how intricate collaboration among all participants can achieve outstanding and timely clinical outcomes. Consider collaborating with ProgenyHealth to help you deliver healthy outcomes to some of your most medically fragile members.

“Alone we can do so little; together we can do so much.” – Helen Keller

About the Author:

Debbie Sweeney, RN, MSN, MBA, is Vice President of Quality, Compliance and Network Expansion at ProgenyHealth. She is accountable for all aspects of both the Quality Management and Corporate Compliance programs, and is responsible for the successful integration of new client business. Debbie has more than twenty-five years of experience in the managed care sector, including commercial and government-sponsored programs.