Optimizing savings levers

Optimizing savings levers

ProgenyHealth optimizes savings levers for comprehensive Maternity & NICU Care Management

With nearly 20 years of experience, ProgenyHealth has a distinct vantage point on maternal and infant health. We know that early-stage maternal health plays a significant role in outcomes, long-term health, and quality of life for women and infants while reducing the associated costs.

We focus early and often on maternity milestones

Here’s how we work to ensure healthier pregnancies:
ProgenyHealth Supporting Moms

We educate women from conception through their return to work.

ProgenyHealth Plan Development

We develop a care plan with women and collaborate with their physicians.

ProgenyHealth Managing Chronic Conditions

We manage chronic conditions that impact a pregnancy (examples: diabetes, high blood pressure, depression, anxiety).

ProgenyHealth Coordinating DoctorVisits

We help coordinate doctor visits, prepare women for those visits, and explain doctors’ orders.

ProgenyHealth SDOH

We solve Social Determinants of Health (SDoH) issues that interfere with healthy pregnancies, physician appointments, and raising a healthy infant, including transportation, childcare, housing, food, and more.

Our program is designed to optimize savings levers for Maternity Care Management to drive:

  • Decreases in first-time C-sections and preterm births,
  • Healthier infants with longer gestational ages
  • Enhanced member engagement,
  • Better identification and referral of behavioral health issues, and
  • A reduction in the total cost of care and improved member satisfaction.

Our coordinated approach focuses on supporting healthier pregnancies and deliveries, fewer premature/complicated births, higher infant birth weights, and fewer NICU admissions.

Should a NICU event occur, we reduce costs and improve outcomes through multiple NICU savings levers

NICU claims make up a relatively small percentage of a plan’s total claim volume but consistently represent the top 1% of costs. These cases are also complex. Utilization and case management are critical to improving outcomes for all. Our team and technology work together to improve maternity population health and reduce total case costs.

At ProgenyHealth, Maternity Care Management, NICU Care Management and Payment Validation & Assurance are all we do. We have managed more cases than most plans see in several decades.

ProgenyHealth: UM & CM Programs

Our track record of success includes an ROI of 2:1 or better

For NICU Care Management, we deliver 12-16% savings, a 10-15% reduction in Length of Stay (LOS), up to a 50% reduction in readmissions, reduced ER visits, and a 90%+ member satisfaction rate.

We apply clinical criteria to ensure accurate NICU billing

Our evidence-based methodology and interventions help rebalance the billing level distribution to less costly days. 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 they become less costly. 

Should a NICU event occur, 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. 

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
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
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

We manage the average length of a NICU stay

Average length-of-stay (ALOS) is a steppingstone 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.

Our comprehensive, integrated UM and CM help infants come home healthy and at the right time.

ProgenyHealth: Reduced ER Visits

We reduce NICU infant hospital readmissions / ER visits

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-Progeny and 1,312 Progeny 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 in the first year of life. Our CM team leverages a national knowledge set and local community resources to provide the right support to the families when they need it most.

Learn how we help ensure payment validation & assurance for your NICU claims.

Get our latest insights on NICU population health management