Paradigm helps our clients by serving as a medical hub connecting injured workers to medical experts, high quality providers and a clinical support infrastructure. We do this using Systematic Care Management℠, our proprietary medical management system. The methodology integrates and coordinates healthcare and case management services to achieve the industry’s best medical outcomes for the most complex claims.
Since treatment for those with catastrophic and complex injuries requires deep expertise, and involves multiple facilities and providers over a period of years, these claims have an increased risk for complications. Systematic Care Management supplements the treating medical team with a welcome, coordinated safety net to help mitigate missed information, inconsistencies between provider practices, medical errors and general fragmentation.
Systematic Care Management includes:
Physician led consultative team with onsite nurse case managers
Comprehensive recovery planning
Access to top providers and centers of excellence
Administrative infrastructure designed specifically for complex cases
Proprietary analytic models and 20 years of catastrophic and complex case data
One-of-a-kind outcome guarantees
Our Approach and Results
We wrap a complete team of experts around the injured person, including a nurse case manager, medical director, account team, clinical team, and medical specialists. As a result, we achieve 5 times better medical outcomes, compared to industry benchmarks, as detailed in Figure A. This ultimately translates into substantial savings for our clients.
Paradigm built the comprehensive, Systematic Care Management model specifically to address the needs of those with catastrophic and complex injuries, including traumatic brain injuries, spinal cord injuries, amputations, burns, wounds and chronic pain. We offer our workers’ compensation carrier and large employers clients a variety of services including:
Outcome Plans for acute catastrophic injuries such as traumatic brain injuries, multiple traumas, spinal cord injuries, amputations and severe burns.
Complex Large Loss Plans for legacy cases with persisting problems such as chronic wounds, recurring hospitalizations, recurrent infections or escalating medical needs.
Pain Management for emerging or chronic pain conditions including fibromyalgia, failed back syndrome and approximately 30+ other pain diagnoses.
Portfolio Medical Management for complex large losses and pain claims wherein we guarantee reserve reductions for the entire portfolio of claims
At Paradigm, we pride ourselves on providing the best results for people with complex medical needs. For more information on our full service offerings, please feel free to contact us or call: 800-942-1725. We also invite you to join our social communities on Facebook, Twitter, LinkedIn, and YouTube.
This week, Dr. Richard Adams, Paradigm’s medical director and brain injury specialist, provides us with his insights and the evidence for “disorders of consciousness” or “slow to recover” programs seeking to address the brain injured patient with low level of functioning. It is critical to understand the evidence for and prognosis of brain injury patients in these programs.
Slow to recover brain injury programs, previously known as “coma stimulation,” play an important, and sometimes ignored, role in the functional recovery of injured patients. The overall goal of this type of neurorehabilitation program is to provide an environment which maximizes functional recovery through the use of neurostimulation techniques, and medical management to prevent complications which can prolong potential neurological recovery.
The need has evolved over the last 20 years as the number of severe brain injury survivors has increased due to improvements in critical care management and rehabilitation treatment. While many of these survivors will go on to achieve significant recovery of function, as many as 10-20% will remain in prolonged states of severely reduced consciousness for a period of time or permanently. These survivors do not meet the criteria for admission to an acute rehabilitation facility (e.g. active participation in therapy for 3 hours per day with specific goals for functional recovery) due to their low level of cognitive functioning.
This has led to the development and growth of specialized programs staffed by therapists and physicians trained in neurorehabilitation. The programs are usually located in a variety of settings, including long-term acute care hospitals (LTACs), subacute congregate residential homes, subacute skilled nursing facilities and acute hospital transitional units.
Slow to recover brain injury programs provide systematic structure and goal directed interventions/strategies including range of motion exercises, positioning protocols and schedules, bowel and bladder management, and treatment of abnormalities of muscle tone (e.g. spasticity); management of heterotopic ossification; management of autonomic dysfunction; tracheostomy protocols for removal; maintaining optimal skin condition; protocols for assessment to evaluate change in physical as well as cognitive status; treatments to alleviate pain and/or physiologic sequelae of procedures involving noxious stimuli or interventions; and family/surrogate education and training in clinical management.
At this time, due to lack of evidence-based medicine, guidelines are limited regarding length of stay. However, many rehabilitative experts empirically recommend a length of stay for 6-12 weeks with 10-15 hours of structured therapy per week. If the individual has not shown cognitive improvement indicating potential to meet the admission criteria for an acute rehabilitation facility, then it is appropriate to transition the individual into a long-term environment. This does not mean there will not be further recovery, but it is unlikely the recovery would be to a level of functioning qualifying the individual for acute rehabilitation. Rehabilitative re-evaluations should take place at 6, 9 and 12 months before determining permanency.
The natural history and long term outcome of “slow to recovery” individuals has not yet been adequately investigated but clinical experience suggests that many of these individuals will recover to a level of meaningful activity which may not occur if not placed in the appropriate stimulating environment.
These programs continue to provide an enriching environment to maintain comfort, eliminate complications and optimize functional recovery. We need to move away from warehousing individuals who initially are at a low level of functioning until a sufficient amount of time has passed to allow for further recovery.
Did you know, over two hundred thousand people are hospitalized for traumatic brain injuries every year, with many injuries occurring in the workplace? And even worse, at least five million Americans currently have a long-term or life-long need for assistance as a result of a traumatic brain injury that can cause behavioral, mood, and cognitive disorders. Fortunately, appropriately managed care in workers’compensation can significantly improve the quality of life for those injured.
Today, I spoke at the IRSG (Insurance Rehabilitation Study Group) Annual Conference in San Diego on caring for the catastrophically injured worker. The IRSG’s mission is to provide an educational forum for the insurance industry to explore and develop concepts and programs of effective medical and rehabilitation services that pertain to all lines of insurance. The vision of IRSG is to serve as an innovative leader by promoting and advocating quality care and service delivery; through education and shared knowledge between members, the insurance industry and the healthcare community.
As a critical care physician, I help to support patients through catastrophic injuries or severe illnesses that have caused one or more organ systems to fail. Some people have overwhelming sepsis and require fluid resuscitation, antibiotics and medications known and vasopressors that keep their tissue perfused. Some may require hematologic support from massive injuries and hemorrhage, and require multiple blood product transfusions. Others may require life support in the form of mechanical ventilation to support a failed respiratory system. In the end, my goal is to support them through the crisis, cure the illness as I am able, or support others, such as surgeons who may be needed to provide some additional form of definitive therapy.
In critical care, we support failed organ systems with the expectation of recovery. We also deal with many subspecialists, ranging from trauma surgeons to neurosurgeons, from infectious disease experts to cardiologists. Each of these specialists provides an expertise in support of our goal of caring for a critically ill patient. Treating catastrophic injuries frequently requires the involvement of several specialty areas: trauma/orthopedic surgery, spinal cord injury and brain injury specialists (both within physical medicine and rehabilitation) and burn surgery. Together, these four specialty areas cover the predominating injuries in catastrophic cases, and make EXPERTISE in those areas key to successfully caring for catastrophically injured workers.
Most physicians and clinicians involved in health care know what it is like to get the call from a friend or family member asking for help with whatever illness or injury that someone important to them is suffering from. They are looking for someone knowledgeable that may be able to help them. They are looking for an ADVOCATE for the injured or ill person.
So, when you boil it down, the keys to caring for catastrophically injured workers are coordinating EXPERTISE and ADVOCATING for the injured person. When you have a system that supports that process and a mission to achieve the best outcome for the injured worker, you do just that.
Next week, Dr. Nathan Cope will start a two part series on neuropsychiatric manifestation and complications in traumatic brain injury.
Welcome to Outlook on Outcomes. As Chief Medical Officer, my goal for this blog is to provide current information and perspective on health care with a specific focus on catastrophic care and chronic pain. To start that process, I would like you to consider health outcomes from a global and longitudinal perspective.
The model of care for workers’ compensation revolves around the idea that carriers “own” the costs of medical care associated with the specific workplace injury and its sequelae for the lifetime of the worker. In other words, they have both global and longitudinal responsibility for the costs for delivery of care. In comparison, group health carriers “own” the cost of medical care only for the term of the coverage or policy, which typically lasts for one year. So, while they have global responsibility, it is for a limited time horizon. Understanding the lifetime responsibility of workers’ compensation carriers will help to understand why the ultimate outcome is important to both the injured worker and the carrier.
Dr. Nathan Cope, who founded Paradigm 20 years ago after many years working with catastrophically injured workers, developed a program that focused on how to eliminate the challenges and barriers to getting injured workers the best outcome from their injury. He understood that workers’ compensation had this unique lifetime responsibility and perceived the need for a better approach to getting superior outcomes through efficient and effective care. He also recognized that there are many variables which account for the variation in care received: demographic and clinical variables of the individual, utilization characteristics of the system and providers (overuse, underuse, misuse and abuse of resources), as well as medical cost variation based upon geography, local laws and practice patterns, and availability of services.
Dr. Cope took the opportunity to create a systematic approach of assessment, intervention and expert clinical oversight to get injured workers prompt, efficient and effective health care that had as its goal the best possible clinical outcome. In other words, he asked, “What was the best outcome that could be achieved by planning and coordinating resources appropriately?” His idea was that this comprehensive approach would get better clinical outcomes and reduce wasteful spending. Since that time, the approach has been validated in spinal cord, traumatic brain, burn and complex traumatic injured workers and their ability to return to function and work.
There are several reasons that this approach works well. First, workers’ compensation carriers view the injury from time of loss until final resolution of outcome. In other words, instead of looking at the injured worker in a 12-month period like a group health patient, workers’ compensation carriers have responsibility to see the injured worker through to the final resolution of injury. Second, everyone wins if the injured worker gets the best clinical recovery and returns to work—the injured worker, the employer and the insurance carrier. The better the recovery that is achieved, the more able the worker is to return to a productive life and the less financial cost of care for the carrier (as a result of the reduction in future ongoing care needs due to the recovery).
To get there, one has to maintain a longitudinal focus on care with an eye toward how each element of treatment impacts that final goal of the best possible outcome. The approach includes the acute care, rehabilitation care and subsequent long-term care that may be required. Dr. Cope’s approach to these high complexity, catastrophic cases is to conduct detailed clinical assessments supported by comprehensive, expert-led clinical plans that weigh how the individual components of care factor into the final outcomes. Obviously, not every injured person needs the intensity of resources that Paradigm provides its catastrophically injured workers. Collectively, the medical expertise exists in our healthcare system to facilitate planning for injured workers, or anyone, and simply needs to be applied.
As we look at health care for the future, wouldn’t it be interesting to consider a global and longitudinal approach to providing health care for each individual? Shouldn’t we strive to understand how the choices along the way impact the final outcome at the end of a long life? How can we account for those choices in a meaningful way so as to encourage the propensity to achieve the best outcomes in our own health?