Virginia Premier opts for data-driven NICU case management

Virginia Premier plans to use ProgenyHealth’s neonatal intensive care unit utilization management and case management program.

The managed care organization, which is a not-for-profit managed care organization wholly owned by VCU Health System, hopes to use the system to better contain costs and improve care for fragile infants born prematurely and receiving intensive care in specialized units.

ProgenyHealth uses a data-driven approach to achieve NICU utilization management and case management, the company contends. The company’s business model empowers its team of neonatologists and NICU nurses to work collaboratively with families and providers across the country, supporting evidence-based best practices, enabling timely discharge from the NICU.

“These infants represent a very complex, vulnerable population,” says John Johnson, chief medical officer of Virginia Premier, head of the initiative to improve NICU outcomes for the plan. “It’s a tough time for our member families, a challenging situation for providers working in the NICU and a significant system cost.”

NICU cases are consistently in the top one percent of a health plan’s most costly claims, according Dan Feruck, chief revenue officer at Progeny. “The challenge for plans is not just that such cases tend to be very clinically complex and costly, but also that they occur infrequently relative to their total member population,” he says.

“Essentially, it’s a high-cost scenario that requires specialized expertise to manage effectively, but that’s difficult to do when the volume is low,” he adds. “Specialization is crucial in this scenario to help improve outcomes related to both care quality and cost.”

Progeny has helped its health plan clients to achieve average lengths of stay 20 percent less than the national average, Feruck says.

“In a study of 3,529 non-Progeny and 1,312 Progeny commercial NICU babies in the same market, our solution helped reduce readmission rates by over 50 percent,” Feruck contends. “By managing all of these variables, we consistently enable our health plan partners to reduce their NICU case costs by 10 to 15 percent, across populations and payment environments.”

ProgenyHealth uses an extensive evaluation process to identify and address social determinants of health, aided by a database of geo-specific resources that helps ProgenyHealth connect moms and caregivers with the resources closest to their homes, Feruck says. “We are constantly generating and storing data through this process, which can help identify resources in areas where our contracted database is limited in scope.”

Progeny also offers a mobile app called Baby Trax, which helps to educate moms and connect them with caregivers and case managers throughout the crucial first year of life.

Progeny’s UM application was designed to be infant-centric and features trigger alerts, which makes it easier the care team to access the data they need, and act upon it at the right time, Feruck says. “All of this means that our team, using our customized dataset, is empowered to perform a focused evaluation of the care being provided to each infant during and after the NICU stay. This clinical specialization coupled with data integration is really our key to optimizing NICU outcomes.”