Our Solution
As your trusted partner, we support your members at every stage of their journey
Personalized support is more than a buzzword. Our whole-person approach supports your members through the maternity, NICU, and postpartum journey by tailoring the resources, modalities, and contact frequency needed to meet every individual’s unique needs.
Watch VideoIt’s not the destination; it’s the journey.
We call it the continuum of care.
From prenatal health, through a possible NICU stay, and up to 12 months post delivery, we work with payers, physicians, and families to ensure the best possible outcomes for every expecting individual.
Maternal Health
NICU Infant Health
Payment Integrity
Maternity Case Management
We support your members through pregnancy and up to an entire year after delivery
We stay closely connected to women and act as their trusted advocates – identifying risks, solving for needed resources, offering educational and emotional support, and helping with the transition to home and back to work.
Timely Identification
Our platform identifies risk in a timely manner to help reduce pregnancy-related medical concerns, preterm births, NICU stays, and complications during and after delivery.
Case Management
Our Case Managers help address medical and non-medical health risks, create personalized care plans, and leverage trusted relationships throughout the maternal continuum, ensuring a proactive and comprehensive approach to Case Management.
Solving Social Determinants of Health
Maternity and NICU Case Managers proactively identify non-clinical risk factors and solve these gaps to help reduce their impact on maternal and infant health outcomes.
NICU Utilization & Case Management
During a NICU admission, we support infants and families while lowering the overall cost of care
Through every critical NICU milestone, our Care Management teams ensure your newborn members, caregivers, and families get the right care at the right time and place. Each newborn is assigned a dedicated NICU-experienced Utilization Management nurse, Case Management nurse or social worker, and a Medical Director.
Ensuring Accurate Levels of Care
Our evidence-based methodology and interventions help rebalance the billing level distribution to less costly days, as applicable. 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 revenue codes billed match their clinical situation and progress. 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.
Managing Length of Stay
Average length of stay (ALOS) is a stepping stone 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 with a customer average of 16 days or better. Our comprehensive, integrated UM and CM help infants come home healthy and at the right time.
Reducing ER Visits and Hospital Readmissions
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-ProgenyHealth and 1,312 ProgenyHealth 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 up to the first year of life. Our CM team leverages a national knowledge set and local community resources to provide the right support to families when they need it most.
NICU Payment Validation & Assurance
Uncover lost savings related to NICU claims
NICU cases drive some of the highest rates of unwarranted spending. Our NICU Payment Validation & Assurance program reviews 100% of all NICU claims and flags the 20-30% with billing inconsistencies.
NICU Claims Review Approach
ProgenyHealth leverages technology and a hands-on approach. Our specialized neonatologists, NICU nurses and certified medical coders perform a thorough review of every claim to uncover savings that other payment integrity companies miss.
NICU Claims Validation
ProgenyHealth reviews the coding in the claim using the clinical data received during the UM authorization process. Our team ensures it is consistent with the clinical rationale supporting the authorized services of the inpatient stay.
Utilization Management Integration
Our integrated approach leverages UM, claims data, common access to medical records, and specialized clinical expertise to deliver the speed and accuracy needed for true NICU payment integrity.
If there are no findings, there is no cost to you.
“ProgenyHealth has been an outstanding partner…”
“Our medical management team worked closely with the experts at ProgenyHealth to deploy this integrated and very effective program. 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
Read the Overview:
ProgenyHealth Overview
Only ProgenyHealth brings personalized maternity case management, NICU utilization and case management, and NICU payment integrity – all under one roof.
We are your trusted partner for better outcomes
Let us help manage your members’ maternity journeys from pregnancy to one year postpartum.