NICU Care Management Program Overview

How the Program Works | The Care Management Team | Alere Care Management Process | Our Value

How the Program Works

Once Alere forms an agreement with a health plan or insurer to provide comprehensive care management for infants and families, our care manager and neonatologists will work collaboratively with a health plan or insurer's network of providers, including their neonatologists and NICU staff nurses, to manage the care of their NICU infants. We will then coordinate an infant's entire episode of care, beginning with their hospital stay through their discharge to their home or an alternate care site (including homecare).

Throughout the care event, Alere medical directors (all of them neonatologists) and care managers (all NICU nurses) provide on-going case management — which includes regular rounding on each complex infant and expert consults for highly-complex newborns — and connect regularly with families of NICU babies to help prepare them for discharge and the future care of their infant. Our evidence-based care management approach helps infants reach milestones sooner and transition smoothly to home.

Primary goals of Alere's NICU program include:

• Promoting the highest-quality NICU care for each patient through on-site care management and collaborative working relationships with attending physicians and nurses
• Encouraging family involvement during an infant's NICU stay and educating parents about their infant's condition to promote more informed decision-making
• Managing the discharge-planning process and stabilization of an infant at home
• Analyzing collected data to identify clinical practice benchmarks and define the highest quality care practices
• Assuring appropriate use of resources
• Emphasizing personalized attention, family advocacy, and family satisfaction throughout the entire care event

The Care Management Team

Alere focuses on both the infant and his/her family. Each Alere care manager provides ongoing support for families throughout their infant's hospital stay and transition to home. During the infant's NICU stay, the care manager utilizes a copy of Baby Steps in their ongoing conversations with the infant's family. This unique, family-friendly set of educational materials is available in both English and Spanish, and aids families in understanding the steps that their infant will take to grow, develop, and transition home.

These efforts help ensure that families are knowledgeable about their infant's needs and are both eager and ready to take care of their infant at home. Throughout the care management process, Alere relies on strong physician leadership. Our medical directors are all neonatologists with recent and broad practice experience. Each medical director is committed to Alere and the infants we manage as a result of their interest in how appropriately applied managed care can benefit infants, their families, and the larger practice of neonatology.

We also utilize nationally-recognized specialists and sub-specialists as consultants for the most complex cases to ensure that all infants have access to exceptional medical services.

Alere Care Management Process

Alere's care management process is systematic and focuses on the coordination and integration of services needed by infants and their families during a defined episode of care, usually from admission to the NICU/special care nursery through the transition to home or any needed homecare services.

Alere care managers manage this process by achieving these primary goals:

• Assuring quality of care
• Promoting optimal clinical outcomes
• Facilitating cost-effective resource utilization

In carrying out their role, Alere care managers also strive to:

• Advocate for infants and their families
• Promote an appropriate plan of care for each infant
• Establish collaborative relationships with physicians and nurses at participating hospitals
• Ensure that all infants receive the appropriate services, at the proper time and in the most appropriate setting
• Educate family members about the dynamics of their infant's condition and the future care their infant will require
• Coordinate and integrate infant care services with providers and health plans
• Facilitate infant and family access to health services and providers
• Match infant and family needs with appropriate benefits and community services

Alere also emphasizes provider performance assessment, reduction in unwarranted practice variation, and information reporting - elements that produce the best outcomes and most effective resource use.

Throughout the care management process we:

• Monitor and measure along the continuum of care
• Collect and analyze data
• Validate quality outcomes
• Avoid micromanaging any practice or practice system
• Document patient management in relation to clinical expectations
• Promote the treating physician's authority over clinical decisions
• Support medical ethics
• Relate care management to the neonatal care continuum
• Rely on our National Neonatal Scientific Advisory Committee to validate policy
• Encourage scientific scrutiny of results and processes

Our Value

Alere's NICU program improves clinical outcomes, achieves appropriate lengths of stay, minimizes readmissions, and aids in an infant's transition home. Our program also provides many non-economic benefits, including high levels of family and provider satisfaction, support for NCQA initiatives, and a reduction in neonatology practice variations.

Alere's NICU program provides these quantifiable benefits:

• Improvement in clinical and financial outcomes
• Refinement in evaluating each infant's level of care
• Reduction in the number of unplanned readmissions
• Enhancement in family satisfaction
• Reduction of reinsurance risk
• Enrichment of provider feedback
• Positive return on investment (ROI)