Here’s the answer: 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.  

• 60,000+ NICU managed cases to-date. More than most health plans see in 10 years.
• 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.
• Success in all payment environments.

ProgenyHealth has a proven solution for the high-cost challenge of covering NICU infant care. And while such case volume may seem relatively small, NICU admissions, as a percentage of all births, continue to increase as a result of many societal factors, including Neonatal Abstinence Syndrome (NAS) and lack of access to, or compliance with, good prenatal care.

NICU population trends

The US prematurity birth rate is nearly 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

That often means these babies begin their life in a neonatal intensive care unit (NICU) battling a variety of medical complications common to premature infants.

How the nationwide opioid epidemic impacts infants

The devastating implications of opioid addiction among adults are now well publicized. But the implications for infants are equally troubling.  According to a recent Vanderbilt University Medical Center study, one infant is born every 15 minutes with NAS — withdrawal symptoms after exposure to opioids before birth.

And because the opioid epidemic is hitting rural populations very hard, many mothers suffering from this problem lack access to healthcare facilities with the resources and expertise needed to treat NAS infants effectively. The result is potentially worsening medical complications and prolonged length of stay.

ProgenyHealth’s clinical team are recognized thought leaders in the utilization and care management of infants suffering from NAS. We collaborate with our provider colleagues by discussing cases specialist-to-specialist, as well as developing best practices documents, which help to share our insights gained from working with NICU’s across the country.  

Get our Best Practices for Management of Infants with NAS

Integrated NICU UM/CM that improves infant outcomes and lowers costs

Every day, our team of neonatologists, pediatric nurses, and social workers take on the many unique challenges of NICU case management across the country. 

But the drive to improve infant health outcomes doesn’t end at discharge.  Too often, mom and baby are going from the hospital to an unstable home environment where basic needs of food, shelter, and safety are unmet.  From day one, ProgenyHealth’s comprehensive model has encompassed management of these social determinants of health as vital to the success of our mission.

Making a difference one baby at a time, one family at a time, across the country, and beyond…

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