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.