Our Solution

Our evidence-based methodology and interventions help rebalance the billing level distribution to less costly days, as applicable. NICU bed levels are billed using Revenue Codes 172, 173, and 174. The 174 days are more intensive and expensive. As NICU infants improve clinically toward discharge, we monitor those days to ensure that revenue codes billed match their clinical situation and progress. We positively impact the Revenue Code mix, rebalancing the distribution to accurately reflect the services provided to the infant. The result is less costly NICU days for ProgenyHealth plan partners.

Average length of stay (ALOS) is a stepping stone to savings for all payment methodologies. The national average for NICU length of stay has consistently risen and is now at approximately 20 days. ProgenyHealth’s program improves this average from almost any starting point. We consistently bring ALOS down and keep it down with a customer average of 16 days or better. Our comprehensive, integrated UM and CM help infants come home healthy and at the right time.

Up to 70% of readmissions occur 30+ days after discharge, and most NICU babies who present at the ER are likely to be admitted. ProgenyHealth’s approach reduces readmission rates by up to 50%. In a study of 3,529 non-ProgenyHealth and 1,312 ProgenyHealth commercial NICU babies in the same market, our solution helped drive a 71% reduction in ER visits. Our CM model provides a virtual safety net for the infant and family up to the first year of life. Our CM team leverages a national knowledge set and local community resources to provide the right support to families when they need it most.