ProgenyHealth NICU Insights Blog

How Postponing the Decision to Outsource NICU Leaves Money on the Table

If you work in the corporate world, you understand how bureaucracy hinders decision-making and cripples innovation. Fear of mistakes, the need for control, and aversion to risk all result in lost opportunities for cost-savings, productivity gains, and growth.

For this reason, the Cost of Delay (CoD) has become a critical business metric. According to a McKinsey Global Survey, only 20 percent of respondents said their organization excels at decision making. Most said it was ineffective.[i]

Everything your self-insured customers need to know.

People have babies – that’s a fact of life. Some newborns require a few days in the NICU, while others escalate into million-dollar stop-loss claims.

Self-insured employers can resign themselves to NICU events as inevitable outliers. They might not realize that NICU claims should be actively managed to avoid reaching the stop-loss point when possible. Many employers have ongoing cases that are quietly escalating and accumulating unmanaged costs. Before cases reach the stop-loss threshold, payers need to offer their customers an extra set of experienced eyes and resources to manage their NICU spend.

ProgenyHealth recently attended a national virtual summit that brought together health plan leaders from across the health insurance industry to discuss ways to help businesses prepare and prosper from the changes that are both advancing and disrupting healthcare.

Here are Five Key Topics participants addressed:

Neonatal Intensive Care Unit (NICU) cases make up a small portion of total births, but when they hit, they hit hard. They can trigger catastrophic stop-loss claims, rack up life-changing bills, and upset the work-life routine. In the U.S., more than 75% of expectant mothers plan to go back to work after giving birth,[1] but once the baby comes home, 43% of them end up leaving their careers.[2]

CFOs for self-insured businesses know their expenses to the penny – for example, what it costs to lease office space. But, for one of their highest costs – healthcare for their employees – they may be flying blind.

Unlike the predictability of leasing, healthcare costs vary widely. The cost of the exact same procedure might differ based on region, provider, and negotiated rates. Faced with the out-of-control nature of healthcare costs, CFOs of large organizations are finding ways to cut costs.

For a growing number of workers, high deductible health plans are the only option – a trend that started a decade ago.

The idea behind high-deductible plans was to make sure employees had “skin in the game.” If they had to open their wallets every time they visited a doctor, they would be more selective and less wasteful when using their medical benefits. These deductibles range from $5,000 to $6,000, and while monthly premiums typically go down, lower premiums also increase the risk of crippling medical debt.

Bonding with a newborn after delivery is more than a sacred maternal rite of passage. Those first moments and the days that follow the delivery form a strong attachment between newborns and parent(s) or primary caregiver. Even when medical care interrupts this bonding process, smiling faces establish a deep human connection for the infant to feel she is welcome in this world.

As an organization offering self-insured options to employers, you likely manage some mix of provider networks, quality of care, utilization management, case management, health care analytics, plan administration and more. But what if one of your clients faced a premature or medically complex birth? Do they have access to specialized NICU Care Management?

In healthcare, interoperability is the ability of hospitals, health systems, plans and providers to exchange information leveraging standard formats, and to use it once received. Why is this important?

ProgenyHealth joins the United Nations and other organizations to promote, improve, and celebrate the quality of life of Down syndrome individuals.