Health plans

How health plans improve quality outcomes and reduce costs in the care of NICU populations

These are no longer opposing objectives. Achieving both happens when health plans partner with dedicated NICU UM and CM specialists.

ProgenyHealth is the only national company dedicated exclusively to NICU utilization management and case management

Serving this challenging population has been our sole mission since day-one. Our data-driven, clinical best-practices approach uniquely supports newborns and their families during the first crucial months of life. It results, consistently, in a better than 3:1 cost savings ROI to health plans in any payment environment.

We partner with both Medicaid managed care and commercial health plans across the country to improve outcomes and reduce risks in the care of premature and medically complex newborns.  We’ve been doing so for well over a decade, delivering quantifiable results the entire time.

A focused, high-touch program that works

We’ve talked to health plans across the country who say they don’t have the resources to manage NICU cases efficiently. Many take a hands-off approach, where UM usually authorizes most of what is presented.  It’s not uncommon that a plan automatically authorizes the first 30 days of a baby’s NICU stay. Or even if the first authorization is 7 days, continual approvals end up effectively authorizing 30 days or more. And, CM often doesn’t start until after discharge, is limited in scope, and only for the most complex cases.

ProgenyHealth addresses the inefficiencies in the NICU care formula by proactively engaging providers and families early and often, in hospitals and at home.  Because our clinical staff is solely dedicated to NICU cases, our focused evaluation of the care being provided helps to optimize outcomes.

How do we do it?

By deliberately integrating our process, platform, and people. By aligning all we do to benefit all those we serve – with our highest priority on your most vulnerable new plan members.

Our comprehensive, deliberately integrated UM and CM program impacts the variables that affect quality and cost outcomes the most.

The resource challenge of low-volume, high-complexity NICU cases:

What health plan executives have to say about us…

Your colleagues are talking about ProgenyHealth. Read what they have to say, then contact us to learn more. We’re happy to connect you with them directly for a referral.

“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, President and CEO 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 

“The value and benefit of ProgenyHealth to our members’ health and satisfaction alone is worth the cost.” — Health Plan CEO

“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

How NICU Case Management throughout the early months of life improves outcomes

Our health plan partners have realized as much as a 50% reduction in readmissions within their NICU populations.  We know that, for NICU infants, hospital discharge is only the beginning — a transition to care provided by a variety of outpatient providers and specialists. The ProgenyHealth CM team is fully focused on helping your members through this stressful, confusing time.

Our seasoned CM nurses help moms, dads, and caregivers of NICU babies manage ongoing clinical care needs outside of the hospital, helping them learn how to use and access the healthcare system and local resources. We work closely with the baby’s family to ensure they don’t fall through the gaps in the healthcare system – ones that result in missed appointments or unnecessary care for that infant. Our nurses also encourage regular pediatric visits, breastfeeding, RSV prevention, and other wellness practices to help ensure proper care is delivered in the right environment.

Available 365 days a year, 24/7, our Case Management team answers parents’ questions, provides education and appointment reminders, and coordinates DME and transportation.

Our Baby Trax® mobile app is available for caregivers to learn about and track their baby’s developmental milestones, view recommended articles and videos, monitor sleep, feedings, and more.  They can even use the app to communicate with their ProgenyHealth case manager!  It’s a fun and convenient way we keep your members engaged in our program.

Ready to learn how much your plan could save on NICU cases? Contact us now or download our services overview brochure.