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The ongoing quest to contain health care costs is often hampered by the common misconception that DRG payment methodologies limit the options for Medical Management.

ProgenyHealth has a proven model that care management done the right way, in collaboration with providers, hospitals and families, leads to significant improvements in health outcomes and lower costs.

Over the last decade, ProgenyHealth has delivered consistent results to its clients reducing the costs of both inlier and outlier payments across the NICU population. The complexities of DRGs and the premise that all cases with the same diagnosis, and in the same facility always result in the same payment can obscure the realities of DRG payments. These findings have now been independently validated through a study by Milliman focused on APR-DRGs and MS-DRGs inlier cases.

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How LOS correlates to payment in the NICU | Impact of billed charges on payment | Discussion of the root causes of payment variation | Medicaid and Commercial specific results | Impact of Care Management on inpatient costs
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Written by:

Dr. Ellen Stang photo Scott Harris photo


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ProgenyHealth is the only national company dedicated to NICU Population Health. The study took findings from ProgenyHealth’s extensive NICU database and independently validated them, with the actuaries/analysts at Milliman, against a national database of over $17 billion in NICU paid claims data.

Milliman is among the world’s largest independent actuarial and consulting firms. The company has extensive experience in the payer and hospital market, with a broad understanding of costs trends in healthcare. Milliman is deeply committed to research and data driven solutions to support health care organizations to make informed decisions.