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Posts under: The Business of Health Care

Clinical Conversations Deliver Healthy NICU Outcomes

July 2017 Blog, Health Management, The Business of Health Care no comments

When I joined ProgenyHealth as a medical director, one of the aspects of the job that I found most appealing was the ability to do meaningful outreach to other neonatologists across the country. Having taken care of many medically complex babies as an attending physician in a NICU for eight years, I feel like I can understand what physicians in the community are going through and the challenges they are facing.

One of the best opportunities for engaging with these physicians comes when we at ProgenyHealth partner with a new client. This provides a chance to connect with physicians, and to discuss how their practice patterns can synergize with ProgenyHealth guidelines to improve patient outcomes. These physician-to-physician discussions form a solid foundation from which trust and working relationships are formed. continue reading

The Value of Boutiques in a Big-Box Store World

February 2017 Blog, The Business of Health Care Comments Off on The Value of Boutiques in a Big-Box Store World

Once upon a time, Main Street America was filled with specialty shops that reflected the unique character of the proprietors and offered us very personalized attention. When we looked for a special occasion dress the owner took pride in helping find the perfect fit and if it wasn’t available in the store, they would order it, tailor it, and give us the detailed attention we desired. The florist knew our partner’s favorite color roses and the pharmacist understood the specific health challenges of our families. Specialization and expertise at retail points of purchase are increasingly rare nowadays.

Today we enjoy the convenience of one-stop shopping at national chains that carry the same goods from coast to coast. Our time is valuable so we gravitate towards what is expedient. These mass marketers strive to cover all our needs under one roof. Their big data systems optimize the shelf space, but often I find the selection average. And while it satisfies routine purchases, it falls short when I seek something more unique and personal. For example, while wine is available in the supermarket, I prefer the guidance of the specialty sommelier who helps me better match taste and value. Big box retail stores are losing relevance, while e-commerce and specialty stores grow in appeal. continue reading

ProgenyHealth, a NICU company that was not premature!

January 2017 Blog, The Business of Health Care Comments Off on ProgenyHealth, a NICU company that was not premature!

As we begin a New Year, it’s the perfect time to reflect on the birth of ProgenyHealth and share the story behind its inception…

Ellen Stang, M.D. is a board certified Pediatrician who began her career in private practice in Bucks County, Pennsylvania – a Philadelphia suburb. After many years in private practice, Dr. Stang transitioned into the managed care industry and became a Regional Medical Director at Keystone Mercy Health Plan – one of the largest Medicaid Plans in Pennsylvania. As a Medical Director, she saw how Utilization Management and Case Management programs could make a difference in the quality, cost, and outcomes of care. She worked with nurses and social workers focused on educating members and coordinating the timely delivery of inpatient, outpatient and ancillary services. In her role, she also was part of a case management team that worked with members who faced daily challenges with many social determinants of health that directly contribute to a person’s wellbeing. continue reading

ProgenyHealth – Our Year in Review

December 2016 Blog, The Business of Health Care Comments Off on ProgenyHealth – Our Year in Review

The beginning of a new year is always a great time to consider where we have been and where we want to go. Before we jump into what we want for the future and those New Year resolutions, we should pause and celebrate all that we accomplished during the past year. ProgenyHealth enjoyed much success in 2016.

We experienced outstanding growth in several areas of our business: clients, infrastructure, and workforce. We added new clients and expanded existing client accounts by managing the health and wellbeing of many more NICU babies. Our most recent additions have included health plans in Massachusetts, South Carolina, Michigan, and Hawaii. continue reading

Talk More – Deny Less

October 2016 Blog, Health Management, The Business of Health Care Comments Off on Talk More – Deny Less

What defines an effective patient management vendor? Is it working in a delegated relationship and issuing denials of inpatient days? How about refusing to approve services that might be helpful in moving a patient out of the hospital to home? Maybe making adverse determinations without discussions with medical care providers?

At ProgenyHealth, we don’t believe that any of those things produce effective or sustainable relationships with providers. Instead, we promote proactive and consistent dialogue with our clients’ providers to anticipate clinical needs and prepare for the next level of care. Our nurses and physicians speak directly with the clinicians in the facilities to discuss the care being provided, barriers to patient progress, and anticipated discharge needs. They discuss the best approach to achieving a healthy outcome and, where possible, address discharge needs early. This proactive and consistent dialogue is one of the primary tenets of the ProgenyHealth medical management model. continue reading

ProgenyHealth Growth Builds Implementation Proficiencies

September 2016 Blog, The Business of Health Care Comments Off on ProgenyHealth Growth Builds Implementation Proficiencies

The healthcare industry landscape is continuing to create opportunities for ProgenyHealth and other clinical specialty programs. Health Plans are striving to enhance benefits, payors are demanding NCQA adherence and quality outcomes, and CMS and the ACA are working to expand coverage. All of these factors are working together to lead many health plans to seek support from highly specialized clinical programs – programs like ProgenyHealth – which are uniquely committed to one subspecialty.

This evolving landscape and ProgenyHealth’s emergence as a leader in NICU Care Management has led to a swift upswing in new clients. In fact, over the past year, ProgenyHealth has increased its client base by 50%. We have placed increased emphasis on launching new business efficiently and this has reinforced several tenets that are critical to successful implementations. We’d like to share these principles with our readers who may be tackling onboarding projects now or in the future. continue reading

Living Our Core Values Every Day

February 2016 Blog, The Business of Health Care Comments Off on Living Our Core Values Every Day

As we begin the New Year and make our own resolutions, it’s a fitting time to revisit how your company’s core values present themselves through your work. ProgenyHealth’s core values are essential to the company, as our culture, brand, and business strategies are all grounded in these themes. ProgenyHealth’s eight core values are reflected in each and every one of our employees who live Progeny’s mission every day. In order to provide the highest quality programs, we recruit and work to develop and retain a highly skilled staff. We hire the best, experienced individuals who are specialists in their field. Here’s a story highlighting our values and practice:

Grace is a ProgenyHealth Case Manager (CM) who came to us from a regional hospital with twelve years of experience working in the neonatal intensive care unit (NICU). Her onboarding with us included training on ethics as well as education on methods to build collaborative relationships. With her extensive experience and background, she was an excellent choice for one of our teams that manages drug dependent babies. Her high level of engagement with drug dependent moms was built upon her respect for their individual challenges and desire to help their babies. Moms value our innovative program that help get babies home sooner through advance protocols and evidence-based best practices.

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World Prematurity Day: A Strategy to Impact Care & Costs

November 2015 Blog, Health Management, Stories from the NICU, The Business of Health Care 1 comment

November is Prematurity Awareness Month and today marks World Prematurity Day, where various organizations focus the nation’s attention on premature birth. According to the CDC, last year one in every nine babies was born premature in the United States. That’s approximately 450,000 babies each year.

Premature birth is a major driver of health insurance costs. In 2007, the Institute of Medicine reported that the cost associated with medical and health care services for preterm infants was $16.9 billion, with more than 85 percent of those medical care services delivered in infancy. Comparatively, the average medical cost for a healthy baby is $4,389, but for a premature baby it jumps to $54,194. That is a considerable difference. One strategy to reduce costs is to work with a team of NICU experts who can manage the ongoing care management needs of these high risk infants and their families. At ProgenyHealth, we feel that there is a significant opportunity to simultaneously improve outcomes and reduce the costs to the health care system.

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High-Risk Maternity Management is Just Half the Story

May 2015 Blog, Health Management, The Business of Health Care, Uncategorized Comments Off on High-Risk Maternity Management is Just Half the Story

When I speak with Health Plan Executives or Medicaid Directors about managing the NICU population, their first response is often to share what they are doing to engage high-risk moms or to reduce early elective C-Sections. Certainly, any baby who is carried to full term and avoids the NICU is a “win” for all. Yet, solely focusing on reducing NICU admissions through prenatal programs misses a significant opportunity to help the costly vulnerable NICU population after birth with continuity of care. continue reading

Outsourcing in Healthcare is an Emotional Hurdle!

March 2015 The Business of Health Care Comments Off on Outsourcing in Healthcare is an Emotional Hurdle!

Everybody outsources! Individuals may outsource mundane jobs like lawn care, painting, or housecleaning. Businesses are more likely to outsource, without much thought, jobs that they don’t have the expertise to perform. It could include tax preparation, legal work, or medical care. Just like individuals, many companies struggle with the decision to outsource functions that require specialized knowledge because they believe they should be able to handle everything internally. Sophisticated technology development is beginning to change this type of thinking.
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