Managing the Cost Implications of Improving NICU Infant Outcomes

Posted by Steven Richardson, MD, MS on Feb 6, 2020 10:32:46 AM

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.

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Topics: NICU population health, premature birth, NICU best practices, utilization management

NICU Cost Containment in DRG Environments: What ProgenyHealth Sees that Health Plans May Be Missing

Posted by Jeremy Kreyling on Jul 22, 2019 10:28:25 AM

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.

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Topics: NICU case management, NICU length of stay, utilization management, APR DRG

Honoring a Special Calling During National Nurses Week

Posted by Madeline Szabo on May 9, 2019 3:46:00 PM

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. 

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Topics: case management, social determinants of health, utilization management, National Nurses Week