Our Medical Case Management Services
Services for Catastrophic Injuries and Complex Pain Conditions
Paradigm Outcomes stands apart from conventional case management companies. We focus exclusively on addressing the needs of those with catastrophic and complex injuries, including emerging and chronic pain conditions. All of our medical case management services employ our Systematic Care ManagementSM approach and differ only in the contract terms surrounding duration, guarantee level and scope. Paradigm offers three main services for the workers’ compensation and liability markets.
Paradigm offers Outcome Plans for acute catastrophic injuries such as acquired brain injuries, spinal cord injuries, multiple traumas, amputations and severe burns. Paradigm limits our clients’ risk exposure by offering a case rate to the client and assuming responsibility for all compensable medical costs until the guaranteed medical and functional outcomes are achieved. Our outcome-focused approach to medical management yields five times better medical results, while saving payors 40% on their total medical and indemnity costs, as verified by Milliman, Inc.
Complex Large Loss Plans
Complex Large Loss Plans are suitable for legacy catastrophic injury cases with persisting conditions such as chronic wounds, recurring hospitalizations, ineffective care configuration and other escalating medical needs. Paradigm’s expert medical case management reduces the volatility by correcting the trajectory of medical utilization, improving clinical results and lowering expenses. Paradigm assumes responsibility for all medical costs for a contracted period of time. Aggregate results include 37% medical improvement as measured on Paradigm’s proprietary Management Impact Scale and a 29% reduction in lifetime medical costs and reserves as verified by Milliman, Inc.
Complex Pain Management
Paradigm takes a comprehensive, outcome-oriented approach to pain management. This costly class of emerging and chronic pain conditions includes fibromyalgia, failed back syndrome and approximately 30+ other pain diagnoses. Paradigm’s biopsychosocial model utilizes analytical and clinical case screening, physician-to-physician case review, comprehensive planning, treatment plan adjustments and monthly case management. The approach helps correct underlying problems, promote functional improvement and reduce narcotic usage. Paradigm’s intervention helps injured workers regain their health and return to work, and results in 41% lower lifetime costs, as verified by Milliman, Inc. Further, cases where intervention occurs within one year of the injury experience a 69% success rate in getting people released to return to work, while cases that have progressed for an average of six years since the initial injury experience a 43% release to return to work rate.