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
We educate women from conception through their return to work.
We develop a care plan with women and collaborate with their physicians.
We manage chronic conditions that impact a pregnancy (examples: diabetes, high blood pressure, depression, anxiety).
We help coordinate doctor visits, prepare women for those visits, and explain doctors’ orders.
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.
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.
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.
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.