How NICU Care Management Benefits Employees and Protects Employers

Posted by ProgenyHealth on Jun 3, 2021 12:41:41 PM

Mother on Phone

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]

Employers also get a sticker shock. In a Sun Life study, “liveborn with complications” ($316,800) and “congenital anomalies” ($216,100) scored in the top ten for all stop-loss claims.[3] In another study, 7.7% of preterm infants accounted for 37% of a plan’s total newborn costs – $78,000 more for a preterm infant during the first year of life.[4]

While the numbers are big, the human cost can be bigger. Most new parents dream of a full-term infant, a joyful home life, and a seamless return to work. When a working mom leaves the NICU, that plan is shattered. “How will I manage the bills, the stress, and the complicated care? How will my maternity benefit cover my new full-time job – caring for this infant with her complex medical needs?”

Returning Home with a NICU Newborn

For a working parent with a NICU newborn, returning to work as a productive employee – an expectation during pregnancy – suddenly seems remote and unthinkable. After three or four months of round-the-clock expert NICU care, the responsibility for providing care shifts to the employee.

Case Management blog 2

For the NICU newborn, the requirements for discharge are simple: Can the infant maintain body temperature in an open crib? Can she feed solely by bottle or breast? Can she gain weight steadily?

For the caregivers, the requirements are steeper. Are you prepared for breathing problems and infections? Can you manage sleeping and feedings, special meds, and appointments? Can you deal with pages of billing in the mailbox? Can you recuperate your body amid hit-the-deck parenting? Are you at risk for “baby blues” or postpartum depression?

Case Managers Support the Return to Work

Case Managers provide an emotional, educational, and logistical safety net when the new mom comes home.

For families facing the challenge of caring for a NICU infant, ProgenyHealth’s Case Managers provide a clinical and emotional lifeline. One mom summed it up: “My ProgenyHealth Case Manager helped make a very scary situation a little less scary.” Another mom concurred, “ProgenyHealth was a Godsend at a time when I didn’t know which way was up.”

With HIPAA, employers rarely know if the NICU parent is on a rocky road – or even if she had a preterm birth. Suddenly, H.R. or the supervisor gets an apologetic message, “I’m so sorry, but I am overwhelmed and not coming back.” With that, the employee’s skillsets, relationships, and job knowledge all disappear.

Employers cannot control the clinical issues accompanying a NICU birth, but through ProgenyHealth Case Management, they can support their employee’s return to work. Their employee is facing a cascade of crises for the first time, where the NICU Case Manager (CM) has seen it all and is there to help. The CMs are NICU nurses and social workers who often had preemies of their own. They manage the coming home and returning to work for countless new moms.

“My ProgenyHealth Case Manager helped make a very scary situation a little less scary.”

“We’ve invested time and resources into our staff and systems so that we can better assess these needs with the families we serve,” said SVP of Clinical Operations, Madeline Szabo, RN, BSN. “The result is that not only can we identify these problems, but we directly intervene to solve them. And that means the family is better able to focus on caring for their new baby.”

The Employee and Infant Come Home

When the parent learns that she can take her infant home, she already has a relationship with a ProgenyHealth Case Manager. This relationship began within a couple of days of her baby being born. From that moment, the Case Manager serves as an extension of the care team – someone she trusts.

If the physician comes into the room, shares important information, and then quickly leaves, the Case Manager is available 24/7 to fill the gaps. The CM also coordinates with the hospital discharge planner and manages the checklist – do you have adequate supplies? Medical equipment? Provider appointments?

After the mom is home, the CM performs regular assessments for postpartum depression and the infant’s status. The CM is already up-to-speed with the clinical details collected during the hospital stay. The CM’s are flexible. If the mom needs rest, the CM can call back when the time is right.

The CM tracks every call through Baby Trax, a proprietary platform that creates a digital footprint of the patient’s journey in the ProgenyHealth program, producing a single case record and information source easily accessible to the entire team. If a late-night call reaches a different nurse, she has all the clinical notes and conversations at hand. Should there be readmission, the U.M. team can pick up the case without missing a beat.

1 in 10 babies-1

Clinical Interventions Improve Outcomes: A Case Study

When a NICU infant was discharged to a mom with postpartum depression, the ProgenyHealth Case Manager faced many issues: The child had a congenital birth defect that the mother did not understand. Plus, the mom was not taking medication for her depression, and she had trouble breastfeeding. The CM coordinated behavioral health support, brought in a lactation consultant, educated the mother on infection control and tracked the follow-ups.

As a result, the mom received support for her depression, resolved the feeding issues, and began checking her child’s oxygen levels regularly.

Preparing for the Inevitable

Nearly 1 in 10 babies are born prematurely in the U.S.[5] And, one in six employers will experience a stop-loss claim from a complex birth. If the employer will eventually face this, why not implement a specialty care program to address it when it occurs? A NICU birth deserves specialized attention because when it happens, the opportunity to make a difference is significant. A Care Management program delivers savings on the health of the mother and child and on getting back to work. Best of all, ProgenyHealth is a program that only costs when the event occurs.

Mary, a NICU mom, put it best, “I needed a miracle to get everything resolved. With ProgenyHealth’s support, everything is moving in the right direction.”


[1] “Modern Family Index 2016,” Bright Horizons Family Solutions.

[2] Light, Paulette. “Why 43% of Women with Children Leave Their Jobs, and How to Get Them Back.” The Atlantic. April 19, 2013.

[3] Sun Life Stop-Loss Research Report, 2020.

[4] https://pediatrics.aappublications.org/content/140/4/e20171078

[5] https://www.marchofdimes.org/mission/reportcard.aspx

Topics: Blog, care management, NICU case management, NICU length of stay, NICU outcomes, NICU team, value of expertise

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