How NICU Care Management Saves Millions Today and Tomorrow

Between 2022 and 2024, the number of health plans operating at an annual loss increased from 45% to 71%, an average increase of 13% each year. With 2026 and the accompanying provisions of the 2025 Congressional Budget Reconciliation Act on the horizon, health plans are wise to expect even more rough seas ahead.

Despite this challenging outlook, there remain a number of avenues health plans can pursue in service of improving outcomes and lowering costs. One such area is maternal and infant health. With NICU-related care accounting for 2 of the top 10 most common million-dollar stop lost claim conditions, and medical technology driving even better odds of survival for these infants, plans can expect costs to rise. As these costs increase, so do the saving opportunities associated with acting now. Enter the “cost of delay”.

At its simplest, cost of delay explains how inaction contributes to unsustainable cost growth. When it comes to claims that often elevate to stop-loss, such as NICU care, delaying the implementation of care management solutions means costs continue to mount even as cost-saving solutions are available for implementation. When looking to solve for the NICU cost of delay, health plans should identify a solution that addresses:

1. Level of Care – Any solution should ensure that revenue codes billed match an infant’s clinical situation and progress
2. Length of Stay – The ideal solution should monitor an infant’s condition so that a timely discharge occurs
3. Reduced ER Visits and Readmissions – Keeping infants healthy while educating families can make a significant difference in driving better outcomes

Interested in learning more about the cost of delay and ProgenyHealth’s role in curbing maternal and infant health costs? Check out our white paper “The Cost of Waiting: How Postponing the Decision to Outsource NICU Care Management Leaves Money on the Table”.