Why outsource NICU UM and CM?

Why outsource NICU UM and CM?

That’s the question all of our partners had at one point, and it’s a valid one…

Like many of our current clients, your plan may already have robust and innovative Utilization Management and Case Management programs serving a diverse member demographic. But when it comes to better managing the costs of NICU infant care within the population, the low volume / high cost nature of these cases creates a challenge that is common across the country.

ProgenyHealth NICU UM CM solutions

Here’s the answer: While NICU cases are low volume, these cases require specialized, high touch care management solutions. That’s how health outcomes are improved and costs are managed.

Alarming NICU population trends

The US prematurity birth rate is now 10% and climbing. As cited in this Fact Book from the March of Dimes, the earlier a baby is born, the higher the risk of death or serious disability. On an average day in the US:

  • 1,045 babies are born preterm (less than 37 weeks gestation)
  • 874 babies are born with low birth weight
  • Approximately 1 in 8 babies start life in the NICU – often among the top 1% of utilizers

All of this means that the first days, weeks, or months of these infants are spent in a neonatal intensive care unit battling a variety of medical complications, challenging clinical cases, and costly care management for payers.

Health plans often don’t have sufficient NICU case volume to develop the dedicated programs and staff the specialists required to impact health outcomes and total cost of care.

Large employers have a similar problem and are impacted heavily by catastrophic claims and lost employee productivity related to these cases.

Why payers outsource NICU UM and CM to ProgenyHealth

We are the only national company dedicated exclusively to NICU population health management. Founded and still lead by a pediatrician, our data-driven, clinical best-practices approach uniquely supports infants and their caregivers during the first crucial months of life.

By standardizing care management, solving SDoH challenges, reducing variations in care and empowering families, we drive optimum quality outcomes and ensure appropriate lengths of stay and levels of care —ultimately reducing inpatient costs, physician fees, emergency department visits and readmissions.

    • Deep NICU experience – It’s all we do.  7 days a week.  365 days a year.  Nearly 17 years. Over 71,000 cases managed.
    • Proven ROI – Year after year after year, with integrated payment integrity solutions to maximize program value.
    • Proprietary Baby Trax® platform – Real-time predictive modeling, EHR, workflow solution focus
    • Scalability and ease of onboarding  – Knowledge of state-specific requirements and dedicated Implementation Team
    • High Satisfaction – Members, Health Plans and Providers
Our integrated NICU UM/CM program helps standardize care, bending the medical cost curve in the right direction

Every day, our clinically specialized team – neonatologists, pediatric intensivists, pediatric nurses, pediatric nurses, and social workers – take on the many unique challenges of NICU care management across the country. Together with our plan partners, we are making a difference one baby at a time –  one family at a time –  across the country.

Contact us now to begin improving outcomes for your most vulnerable members.

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ProgenyHealth has helped to reduce our ALOS, reduce outlier days, and keep our readmission rates low. Testimonials from our members are full of praise.
- Health Plan CMO
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.
- Marge Angello, Amerihealth Caritas’ Market President
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.
- Dr. Michael Genord
Chief Executive Officer of Health Alliance Plan