World Prematurity Day: A Strategy to Impact Care & Costs
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.
Take Hannah* for example; she was born at 26 weeks gestation and spent twelve weeks in the NICU. She was born with multiple medical conditions, including chronic lung disease, a heart defect, and difficulty feeding. During Hannah’s hospital stay, ProgenyHealth’s Utilization Manager Nurse performed utilization reviews, peer-to-peer consults to support care (when necessary), and ensured accurate level of care coding that reflected Hannah’s progress in the NICU.
Progeny’s team of NICU nurses and social workers continuously collaborated with the hospital’s discharge planners, utilization reviewers, social workers, and care coordinators throughout Hannah’s hospital stay in preparation for her discharge. Hannah was discharged on home oxygen, with a home apnea monitor, and was on multiple medications. Because of her complex medical conditions, she needed to see multiple specialists. When Hannah was still in the NICU, her mother, Julie,* enrolled in ProgenyHealth’s care management program, a service provided by Julie’s health insurance. During one of Progeny’s outreach calls, the case manager assigned to Hannah’s case, discovered the presence of several barriers to care and as a result Hannah was not making her critical specialist appointments. Keeping up with these appointments was crucial to Hannah’s healthy progression and to eliminating the potential for any hospital readmissions. To ensure that Hannah’s medical needs were being met, the ProgenyHealth case manager enlisted the support of a social worker at Hannah’s PCP office who then contacted the Department of Human Services (DHS).
Through DHS Hannah will be receiving ongoing in-home services. Due to Progeny’s case manager’s collaboration with DHS and the social worker at the PCP’s office, Hannah has the necessary services in place. She is now attending her specialty appointments, and gaining weight. In addition, Julie is educated on Hannah’s conditions and the necessary medical equipment used to treat her daughter.
At ProgenyHealth, our team of NICU experts consists of neonatologists, pediatricians, pediatric and NICU nurses, and social workers. Our focus is on educating members, communicating with providers, and improving outcomes. Our model employs continuous collaboration with physicians, home care agencies, specialists, social workers, and social service companies, to keep all parties informed and working toward the same goal – a healthy outcome. Since 2003, Progeny has been using its model of coordinated care, active provider communication, and family education to achieve healthy outcomes for some of the health system’s most medically fragile patients. This model has led to healthier babies, improved outcomes, and lower costs of care.
*Names have been changed to protect the privacy of these individuals
About Our Author:
ProgenyHealth is a leading provider of neonatal care coordination services. Focusing on the unique health care needs of infants in intensive care nurseries, ProgenyHealth’s neonatologists, pediatricians, and NICU nurses, partner with the infant’s neonatologists and primary care providers to deliver care management services from birth through the first year of life.