Integrated Maternity and NICU Care Management

Integrated Maternity and NICU Care Management

Supporting Maternal and Infant Health

Only ProgenyHealth offers end-to-end maternal care for women, infants, caregivers, and families – from conception and pregnancy to postpartum and parenting.

ProgenyHealth delivers care management throughout the maternal health process to help mothers have healthier, full-term pregnancies. Our industry-leading expertise improves maternal and infant health for normal, moderate risk, and high-risk pregnancies, as well as for complex NICU births and postpartum issues.

Our specialized team of obstetricians, neonatologists, pediatricians, maternity, neonatal, and pediatric nurses, social workers, lactation consultants, and nutrition coaches collaborate to deliver better outcomes while reducing the total cost of care.

ProgenyHealth Mom and Baby

A focused, high-touch program that delivers:

ProgenyHealth Maternity and NICU Case Management

Maternity & NICU Case Management

  • Maternity Case Management – ProgenyHealth Case Managers work with families through the milestones of maternal care – from conception and pregnancy to postpartum and parenting.

  • NICU Case Management – In the event of a NICU admission, our NICU Case Managers support discharge planning, screen for postpartum depression, and provide education and clinical support. Importantly, they also identify and solve Social Determinants of Health. Our proprietary care management platform guides our case management teams and aligns their efforts.
ProgenyHealth Maternity and NICU Utilization Management

NICU Utilization Management

  • Proprietary Data Platform – Data intelligence captured by our proprietary platform, Baby Trax®, leverages nearly 20 years of clinical experience to support clinical decisions and deliver the best outcomes.

  • Optimizing Quality Outcomes – By standardizing care management and reducing variations in care, ProgenyHealth drives optimal quality outcomes and ensures appropriate lengths of stay and levels of care to reduce inpatient costs, physician fees, emergency department visits, and unnecessary readmissions.
ProgenyHealth NICU Payment Validation & Assurance

NICU Payment Validation & Assurance

  • Maximizing value – Our Payment Validation & Assurance program helps prevent inaccurate payments and maximizes value from our UM services. We review claims against clinical authorizations, identify variances between approved days and levels of care, and confirm codes that may impact reimbursement.

  • Accurate Coding – ProgenyHealth identifies billing inaccuracies, analyzes coding, and reduces waste in the payment process.

We’re transforming healthcare for women and infants.

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

ProgenyHealth Expectant Mom

WHY IT MATTERS:
A National Maternity Crisis

America’s maternal mortality rates are among the highest in the developed world. 

17.4

Worst rate of maternal mortality per 100K live births amongst industrialized nations (2018) 1

37% & 47%

Increase in maternity-related costs in Commercial and Medicaid populations 2

7%

Percent of U.S. women reported prescription opioid use during pregnancy 3

Comprehensive Maternal Health

Ensuring healthier pregnancies by:

  • Educating women from conception through their return to work

  • Developing a care plan with women and collaborating with their physicians

  • Managing chronic conditions and other assessed risks that impact a pregnancy

  • Helping to coordinate doctor visits, preparing women for those visits, and explaining doctors’ orders

  • Solving SDoH issues that interfere with healthy pregnancies and raising a healthy infant

Improving Maternity Quality and Decreasing Costs

Implementing maternity levers that can:

  • Decrease C-sections and preterm births

  • Support larger and healthier infants at delivery

  • Enhance member engagement with maternal and infant health

  • Offer better identification and referral of behavioral health issues

  • Reduce the total cost of care and improve member satisfaction

Driving NICU Quality and Savings

Reducing NICU costs and improving outcomes through multiple savings levers by:

  • Applying standard clinical criteria to ensure accurate NICU billing

  • Using evidence-based interventions to rebalance billing levels to less costly days

  • Consistently reducing the length of stay and accurately aligning level-of-care billing

  • Controlling NICU costs by reducing ER visits and unwarranted hospital readmissions
ProgenyHealth Mom and Baby

A proven program with nearly 20 years of experience, ProgenyHealth understands how early-stage maternal health plays a significant role in long-term health, quality of life, and outcomes for women and infants while reducing the associated costs.