Beneath the Surface: The Hidden Risks and Costs that Commercial and Medicaid Health Plans are Missing

Health plans are accustomed to seeing the big picture: rising costs, high-dollar claims, and annual trends. But while these metrics can identify where spending is increasing, they rarely reveal why it is happening or how to address the factors driving those costs. Maternal and infant health is among the most impactful drivers of healthcare spending and outcomes, yet many of the risks that shape those outcomes remain hidden from view.

At the same time, health plans recognize that improving maternal and infant health outcomes is both a clinical and financial priority. The challenge is identifying interventions that can reduce preterm births, improve member engagement, support healthier families, and lower the total cost of care.

ProgenyHealth’s new report, “Beneath the Surface”, explores how connecting clinical expertise, advanced analytics, care management, and claims review can help illuminate gaps that traditional approaches often overlook. From pregnancy through postpartum care and any resulting NICU stay, a more complete view can support both healthier families and stronger financial outcomes, with key performance metrics including:

• 23% reduction in preterm births
• 16% reduction in ED utilization
• 12-16% In NICU savings
• 10-15% reduction in NICU length of stay
• $7K – $10K average recovery per NICU claim reviewed

Ready to look beyond the surface? Download the full “Beneath the Surface” report to discover how greater visibility can help uncover hidden risks, control costs, and improve maternal and infant health outcomes.