Clinical Summary for NICU Case Management

How the Program Works | Facts You Need to Know

How the Program Works

Behind the NICU Case Management program is the proprietary Matria Outcomes Modeling System, which has the capability to estimate the length of hospitalization within days of referral based on birth weight and other key clinical indicators. The system allows Matria to offer flexible management and pricing models and provide early estimates of case management costs, as well as comprehensive outcomes tracking and reporting.

Recognizing that not all infants require the same level of management resources, Matria has designed a highly flexible system to give each case the appropriate level of management support based on birth weight and other medical factors. All patients are assigned a neonatal nurse case manager and have access to an extensive support system of neonatologists, neonatal case managers, neonatal homecare nurses and a 24/7 nurse line.

Clinicians also offer education and emotional support to help prepare families for decision-making, discharge and caregiving after they return home. All patients receive a 30-day case management follow-up, homecare support if necessary and the option to extend their management services after discharge.

Matria's program offers the following services:

Total maternity management. Only Matria offers seamless maternity management, including early identification of risk factors, prenatal preventive services, home-based obstetrical care and postnatal case management services.

Precision predictive modeling. Matria Outcomes Modeling System weighs multiple factors to deliver the industry's most accurate estimates, including clinical indicators, birth weight segmentation and key social factors.

Homecare assessments. Matria's field case managers ensure successful outcomes by assessing the home environment, determining the appropriate discharge date and providing emotional/educational support to the parents.

Optimized discharge planning. Matria begins discharge planning from the very first day to reduce the length of stay, facilitate service-level transitions, assure continuity of care and prepare the family for in-home care of the newborn.

Flexible pricing. Matria provides accurate estimates of costs, care plans and length of stay within days of referral, as well as the right level of management resources and intensity of service for each patient.

Facts You Need to Know

Neonatal and maternity-related costs are approaching catastrophic levels, with families, health plans and employers in the United States dishing out more than $11 billion, most of it for premature infants. Driving the costs are lengthy hospitalizations in neonatal intensive care units (NICUs), which account for 75 percent of charges for pregnancy management.

These occur when infants are born with low birth weights of 2,500 grams or less or very low birth weights of 1,500 grams or less. Based on a report by the U.S. Agency for Healthcare Research and Quality, very low birth weight infants end up costing an average of more than $79,000 in medical costs, while the charge per discharge of a normal newborn is just a little more than $1,000.

What's even more alarming is that some babies can cost millions of dollars to a company if they are born early enough. A baby born just a few weeks shy of the ideal gestation period of 37 weeks could cost as little as $4,733, while an infant born eight weeks early could blow that cost to $49,540. Back the birth up a few more weeks, and the baby could ring up a $1 million bill, and that does not include the 25 percent of the youngest and smallest babies who suffer from long-term health problems after they are released from the hospital.

Birth weight also plays a significant factor in cost. For instance, a baby born at just a moderately low birth weight could cost 46 percent more than an infant born at a normal birth weight.