What is the business case for outsourcing NICU UM/CM?
That’s the question all of our health plan partners had at one point, and it’s a valid one. The bottom line answer is: quantifiable, consistent cost savings.
Many plans already have robust and innovative UM/CM programs serving their broad member populations. But with nearly half of a health plan’s total costs for infant hospitalizations coming from NICU cases, a focused solution is needed.
NICU cases represent a high-complexity, high-cost challenge that requires specialized knowledge to manage effectively
Health plans often don’t have sufficient case volume to develop the programs required to impact total NICU cost-of-care while also maintaining strong network provider relationships. Employers have a similar problem and are impacted heavily by catastrophic claims from these cases.
That’s where we come in. ProgenyHealth is the only national company dedicated exclusively to NICU UM and CM. Our data-driven, clinical best-practices approach uniquely supports newborns and their families during the ﬁrst crucial months of life.
- 65,000+ NICU managed cases to-date. More than most health plans would see in several decades.
- 6,000+ provider contacts in 1,400+ facilities throughout the US, including major children’s hospitals.
- National, regional, and state Medicaid managed care and commercial plan client experience.
Proof positive: our integrated program produces validated cost savings ROI
Within any contracting type or payment environment, ProgenyHealth delivers consistent cost savings ROI of 3:1 or better for our partners. Our comprehensive program manages the major variables that impact NICU case costs throughout the crucial early months of life.
A singular focus on this population; a broad commitment to managing all the clinical and social factors that impact outcomes. This is ProgenyHealth’s solution to the low-volume, high-complexity problem inherent to NICU cases.
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Our medical management team worked closely with the experts at ProgenyHealth to deploy this integrated and very effective program. Their singular focus on NICU babies and their families was crucial to the program’s success, and especially vital in building a collaborative relationship with our providers. We’re very pleased with the outcomes of this initiative and the role it plays in our ongoing efforts to help members most at risk of developing serious chronic conditions.
Progeny has been an outstanding partner. Their clinical expertise in the NICU arena has helped us to manage the care of these infants effectively, and they are completely committed to identifying and addressing the social determinants of health often found in this fragile population.
ProgenyHealth has helped to reduce our ALOS, reduce outlier days, and keep our readmission rates low. Testimonials from our members are full of praise.