Solving the Geographic Challenges of NICU Infant Care Coordination: Matthew's Story

Posted by Madeline Szabo on Jun 24, 2019 11:19:02 AM

md-photo-liAsk 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. 

Imagine then, the exponential impact of a multi-month NICU stay, in a hospital far from home. That’s the story of baby Matthew and his mom, Angela.

Matthew was born in the month of July at 25 weeks gestation (less than 37 weeks is considered premature) and discharged from the hospital in November.  Such infants are at high risk for a variety of medical conditions that require specialized care and monitoring well beyond the inpatient stay. A successful transition home requires a team effort, and the most important person on that team is the parent or other caregiver. In this case, Angela worked closely with her ProgenyHealth Nurse Case Manager (CM), Christine, receiving the customized support she needed to understand and overcome the long-term challenges faced by her baby. 

Matthew’s medical concerns included issues related to prematurity, respiratory distress, reflux and feeding immaturity, tongue and speech development issues, and physical developmental delays. To have the best opportunity for a healthy outcome, Matthew needed follow-up care from specialists at prescribed times after his discharge from the hospital.

Often, such premature infants are seen at a Neonatal Follow-up Clinic to address these medical conditions or other developmental challenges that require special attention. Our CM found such a clinic close to the family’s home that could address Matthew’s specific needs and then helped Angela set up his appointments. 

Additionally, Christine placed a referral to Early Intervention, which allowed for in-home support from physical, occupational, and speech therapists. She also provided Angela with important points to bring up in his routine pediatric visits and secured local referrals for the crucial pulmonary and GI specialists he needed to see. 

To-date, ProgenyHealth’s CM has communicated with Angela over a dozen times, listening to her questions and concerns, and providing her with the information she needs to advocate effectively on his behalf.  So much so, that Angela still eagerly shares her story with impressed physician office staff and her fellow moms.

She states that, “Every time we go to an appointment, I tell people about ProgenyHealth because they’re usually fascinated with how we got to where we are. That’s because I’m very persistent, I’ve been to a lot of appointments, and a lot of specialists. I know every detail inside and out, and I know things a lot of people wouldn’t know.” 

In this case, as in many rural areas across the country, the geographic distance between the birth hospital and local providers was a potential impediment to care coordination. But the proactive intervention of Angela’s health plan made a real difference -- empowering her as Matthew’s caregiver and helping make a positive health outcome much more likely.

To summarize in Angela’s words, “To me, ProgenyHealth is a vital resource that I’m grateful our insurance provides. If you can get behind these kids when they’re very tiny and still developing, it can make a significant difference in their overall outcomes. And that’s going to cost less in the long run. Everybody has a vested interest in providing this for families that have medically needy children.”

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Madeline Szabo is Senior Vice President of Clinical Operations at ProgenyHealth

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Topics: NICU case management, preemie, social determinants of health