Member Journey

Supporting Women, Infants & Families Through Every Critical Touchpoint

From pregnancy to postpartum, we deliver continuous, coordinated care to improve maternal and infant health outcomes.

Positively impacting maternal and infant health outcomes requires a whole-person, integrated, and sustained approach. Learn more about the vital touchpoints along the member journey that are included in the ProgenyHealth program.

STEP 1

Awareness

Ensuring that members and their provider teams understand the benefits of a Maternity & NICU Care Management program is an essential first step. As with any population health program, we advocate for regular member communications that will drive awareness and ultimately enrollment. Our Marketing and Communications team will work collaboratively with your team to craft an ongoing communications strategy to both eligible members and providers.

STEP 2

Referrals

Members eligible for the Maternity program are identified through various methods, including provider referrals, claims and authorization data, health plan referrals, mobile app downloads, and self-referrals. Once a member is identified for the program, we will outreach the member telephonically to explain the benefits of our program and offer them the opportunity to enroll.

Self

Provider

Health Plan

Claims Data

STEP 3

Enrollment & Empowerment

Members may enroll into the program either through our mobile app or through telephonic case management (or both) – offering multiple modalities for engagement is key to making enrollment easy and to accommodate member communication preferences. Providing members with multiple engagement options empowers them to take a more active role in their maternity journey.

STEP 4

Risk Screening

You can’t manage risks if you are not identifying them. We assess members’ risks upon enrollment and continuously monitor them throughout the pregnancy to identify any changes indicating increased risk. We identify clinical and behavioral factors, as well as social determinants of health, to help set the stage for personalized support.

STEP 5

Health Assessment
& Risk Stratification

Our team completes a full health risk assessment and assigns a program owner based on the results and the needs identified. Our Nurse Case Managers support members with high and medium clinical risk factors, our Social Worker Case Managers support members with high and medium non-clinical risk factors, and our Care Coordinators provide information and support to members who are low-risk. Everyone – regardless of risk – has a designated support structure along with access to our mobile app, which allows our team to monitor rising risk along their journey.

STEP 6

Case Management

ProgenyHealth’s specialized team provides both complex case management and care coordination, depending on the member’s risk level. All members have access to a mobile app that provides customized content based on the member’s profile. Members requiring complex case management receive a specific plan of care, as well as frequent phone calls and texts from their dedicated case manager.

For members receiving care coordination, our team provides continuous risk monitoring, trimester outreach, and access to our team should they have questions or concerns. In this way, the Case Management Team serves as a partner in your members’ health.

STEP 7

Baby Delivered

Upon receiving a delivery notification, our team conducts a postpartum assessment. We screen for postpartum depression and other behavioral health issues, provide breastfeeding support and ensure that your members attend their postpartum appointments. Our team also provides parenting support, education, and resources to ensure the new baby is appropriately connected to care.

Depression
Screening

Breastfeeding
Support

Appointment
Adherence

STEP 8

Coordinated Care

Even after delivery, we stay connected to your members for 12 months postpartum. If mom delivered a healthy newborn, we provide ongoing parenting education and support. If the baby required a NICU admission, our specialized NICU Care Management team goes into action, collaborating with NICU hospital teams and providing increased family support.

STEP 9

Program Graduation

Once the families we serve have reached their final milestones of the program, they graduate and begin the next phase of their parenting journey. When members have ongoing needs that extend beyond the 12-month postpartum period our team coordinates with the health plan’s case management team to ensure continued support and continuity of care.