One challenge health plans face is how to convert patient information into timely interventions that enhance the member experience while identifying and reducing unnecessary costs.
ProgenyHealth’s technology can look beneath the surface of claims data and find hidden insights and costs that Medicaid and commercial plans are missing to help them improve maternal and infant care. A new report offers examples of how it can serve as a vital collaboration partner to Medicaid and commercial health plans.
On the surface, clinical risk, social drivers of health, NICU utilization, postpartum needs, and managing rising costs may appear to be separate challenges, but they are all parts of the same picture. The report offers examples of how maternal and infant care can be improved as well as ways needless expenses can be identified.
Identify risks in specific patients
The report highlights a case of a pregnant woman in her 20s who has attended most of her prenatal appointments. ProgenyHealth can examine the patient data to identify a mother of a one-year-old who is experiencing leg pain, lacks reliable transportation for her medical appointments and has obesity, increasing the risk for complications.
NICU utilization
Using the example of a newborn in the NICU for 45-days, ProgenyHeath shows how it can offer insight to support daily level-of-care decisions, length-of-stay appropriateness, and whether there are ways to reduce variation in care. It can also highlight indicators of clinically appropriate discharge readiness.
Overpaying and overbilling
ProgenyHealth also takes on increases in healthcare costs by highlighting multiple diagnosis codes that don’t align with the level of care delivered. It can also call attention to recurring errors across claims to identify avoidable overbilling.
To download the white paper Beneath the Surface: The Hidden Risks and Costs Commercial and Medicaid plans Are Missing, fill in the form below: