Health plans

Health plans

We serve women, infants, caregivers, and families through the milestones of maternal health, from conception and pregnancy to postpartum and parenting

ProgenyHealth in the Office

ProgenyHealth is the only national, tech-enabled women’s healthcare company dedicated to Maternity and NICU Care Management. We bring special expertise to improving maternal and infant health. We focus on healthier, full-term pregnancies, yet are uniquely qualified to manage pre-term and medically complex births, and the resulting NICU admissions. We improve outcomes, enhance member and provider satisfaction, and lower overall costs of care.

With nearly 20 years of care management experience, our Maternal & NICU Care Management teams consist of board-certified specialists, including obstetricians, neonatologists, pediatricians, maternal/NICU/pediatric nurses, social workers, lactation consultants and nutrition coaches. They collaborate with providers to improve health outcomes and reduce costs for commercial health plans, Medicaid payers, and large employers.

Our program is designed to reduce first-time C-sections and pre-term births, resulting in larger and healthier infants at delivery, enhanced member engagement, better identification and referral of behavioral health issues, a reduction in total cost of care and improved member satisfaction. 

Our track record of success in the NICU Care Management space includes an ROI of 2:1 or better, 12-16% in savings, 10-15% reduction in Length of Stay (LOS), up to a 50% reduction in readmissions, reduced ER visits, and a 90%+ member satisfaction rate. 

How we support your members’ pregnancies

Members access our maternity program in multiple ways: 

  • Provider referrals,
  • Health plan referrals 
  • Self-enrollment via the mobile app, or 
  • Outreach to a ProgenyHealth Case Manager 

Our team supports your members by: 

  • Providing education and support, 
  • Helping set up doctor visits and care plans, 
  • Helping solve life’s challenges, and 
  • Finding pregnancy and parenting resources

Members receive reproductive health education and support through a mobile app – from cycle tracking and help with conception to pregnancy and parenthood.

What happens if a newborn is admitted to the NICU

We match each family with a dedicated Case Manager who supports members from the NICU admission through the early months of the newborn’s life.

Our Case Managers reach out to assess needs, optimize care, and collaborate with hospital staff to support the newborn’s transition from the hospital to home. 

A focused, high-touch program that works:

  • Maternity & NICU Case Management – ProgenyHealth Case Managers work with families through the cycle of maternal care – from conception and pregnancy to postpartum and parenting. Our Maternity Case Managers assist with pregnancy issues. After the birth, our NICU Case Managers support discharge planning, screening for postpartum depression, providing education and clinical support, and helping solve the Social Determinants of Health. Our intelligent platform supports our case management teams.
  • NICU Utilization Management – ProgenyHealth uses data intelligence captured by its proprietary platform, Baby Trax® – based on nearly 20 years of clinical experience – to support providers’ clinical decisions. By standardizing care management and reducing variations in care, ProgenyHealth drives optimum quality outcomes and ensures appropriate lengths of stay and levels of care to reduce inpatient costs, physician fees, emergency department visits, and readmissions.
  • NICU Payment Validation & Assurance – ProgenyHealth’s Payment Validation & Assurance program helps prevent inaccurate payments and maximizes value from our UM services.  ProgenyHealth reviews claims against clinical authorizations, identifies variances between approved days and levels of care, and confirms codes that may impact reimbursement. The service identifies billing inaccuracies, improves coding, and reduces waste in the payment process.

Achieve measurable results

We invite you to meet with our team of health economics specialists who can analyze your claims and reveal opportunities to reduce costs while achieving better outcomes.

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