ProgenyHealth NICU Insights Blog

As the Baby Boomer generation ages and many begin to deal with the usual health issues that come with getting older, much attention has been placed on the costs and resource utilization of medical care for this group. Data from CMS shows that approximately 30% of all Medicare spending occurs in the last year of beneficiary’s lives, with much of that spending taking place in the 6 months just prior to death. As shown on the chart Average Health Spending by Age in the United States, published on RegisteredNursing.org, there is a dramatic upward cost trend as people age. For a moment, let’s turn our attention to the opposite end of the spectrum and examine the often overlooked high costs that can arise at the beginning of life.

ProgenyHealth is the only company in the United States whose sole focus is the management of the care and support of infants hospitalized in the neonatal intensive care unit, as well as during the important months after their discharge from the hospital.  We are privileged to work with over 1,400 NICUs across the US, with our board-certified neonatologists and pediatricians interacting and collaborating with the attending physicians and hospital-based teams to drive the best possible health outcome for each child.

World Prematurity Day (WPD) is recognized each year on November 17.  It has been eleven years since it’s initiation by the European Foundation for the Care of Newborn Infants (EFCNI).  Designed to act as a reminder of the human and financial costs of premature births around the world, the theme this year is one that is often the goal of medical quality improvement experts, health care administrators, payers, and medical professionals throughout the United States:  “Born Too Soon - Providing the right care, at the right time, in the right place.”

In September, NICU Awareness Month, we want to acknowledge that many factors outside of “typical” medical conditions demand holistic solutions in neonatal care. Deficiencies in the social determinants of health can become obstacles that lead to increased risk and poor outcomes, especially within this clinically vulnerable population. Consequently, providers, payers, and caregivers must work together to identify and address these factors which can negatively impact the health status of these infants.

This week marks World Breastfeeding Week, which is dedicated to the protection, promotion and support of breastfeeding worldwide. Breastfeeding is one of the most natural things a mother can do for her baby.  The health benefits for the baby are well known and well published.  Included in Healthy People 2020’s agenda, are measures associated with increasing the number of mothers who choose to breastfeed their babies and goals for the length of time a baby is breastfed as well as improving work place support programs.

Medical costs for newborns are some of the fastest growing in healthcare - mostly driven by infants requiring NICU services. Such cases represent a small percentage of the newborn population (approx. 15%) but consume a large percent of the total cost of care for this group (>40%). The increasing costs are partially attributed to cases where claims are submitted for the newborn’s NICU admission with a single revenue code level that reflects a higher resource use intensity than is documented in the records for the duration of care, resulting in higher than expected costs to the health plan.

Ask any mom or family member who’s been through the experience, and they’ll tell you there’s nothing “normal” about a NICU stay, regardless of how long it lasts, or the relative health of their infant. Even when care is provided by dedicated staff at the best hospitals, the emotional roller coaster ride endures for the entire NICU length-of-stay, which can average 20+ days.

Helping both families and providers during this time (and enabling payers to provide additional benefits and expertise to support them), is critical to reducing overall system costs and ensuring each infant has the best possible chance for a healthy outcome. 

ProgenyHealth is committed to helping providers everywhere with one of the most devastating aspects of the opioid crisis: neonatal abstinence syndrome (NAS). With our newly updated Best Practices for Management of Infants with NAS, our clinical team has addressed major issues affecting these babies and their families. 

From 2004-2013, the incidence of NAS and maternal opioid use in the United States increased disproportionately in rural counties from 12.9% in 2003/2004 to 21.2% in 2012/2013¹.

ProgenyHealth’s team of neonatologists, pediatric nurses, and social workers have managed over 65,000 NICU cases to-date as part of our neonatal medical management service offering. Infants born with neonatal abstinence syndrome (NAS) – symptoms related to opioid exposure in the womb – represent a complex and growing segment of this population. Tackling their unique challenges requires a specialized approach that supports the needs of both the mother and the baby. 

May 6 - 12 is National Nurses Week and this years' theme is "4 million reasons to celebrate".  Like their colleagues everywhere, our team of highly skilled nurses works tirelessly every day to support the health outcomes of the tiniest of patients: infants who are or have been in neonatal intensive care units. 

Premature and medically complex newborn cases are inherently challenging. And when broader variables such as the social determinants of health come into play, ensuring positive outcomes for both babies and families becomes exponentially more difficult. This is the challenge that ProgenyHealth's nurses embrace on a daily basis.