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, but once the baby comes home, 43% of them end up leaving their careers.
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.
Navigating the stressors of a medically complicated birth can seem overwhelming, even for those that may have good health insurance and few barriers to resources. For families struggling to overcome disparities involving the social determinants of health, like lack of access to basic necessities (e.g. housing or food) or even managing addiction or mental health concerns, giving birth to a NICU baby can create further insecurities experienced by the whole family. This is where our team of social workers at ProgenyHealth play such a pivotal role in the lives of these vulnerable infants and their families, connecting them to vital local resources like food and housing, drug rehabilitation programs, and counseling services.
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.
As Neonatal Intensive Care Awareness Month comes to a close, we’d like to remind everyone of the unique challenges that families, providers, and communities face in caring for premature and medically complex newborns – struggles that often endure well beyond infancy.
The March of Dimes is one of the most widely known and respected charities. They’ve been leading the charge for healthier babies and moms for decades, and their mission is near and dear to our hearts here at ProgenyHealth. Fighting Premature Birth: The Prematurity Campaign puts focus on many of the issues that we also face in providing care management services for such infants and their families in the first year of life.
According to CDC data as of 2016 cited in the campaign, 9.8% of all births in the US are preterm (<37 weeks gestation). Unfortunately, the rate of such births is growing, and the national opioid epidemic is contributing to the problem. To-date, a single solution has proven elusive. Until one is found, the best approach is a renewed focus on the issue that encompasses its inherent breadth and depth.
November 17th is World Prematurity Day. At ProgenyHealth, our mission is to improve outcomes for this vulnerable population. Prematurity (birth prior to 37 weeks gestation) is the leading cause of death worldwide in children under five years of age. Here are a few facts illustrating why prematurity remains at the forefront of population management agendas.
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