Carriers and Clients

When the worst accidents occur, carriers and self-insured employers want the best possible recovery for the injured person. They also want to control their medical expenses. Fortunately, these goals are not contradictory with Paradigm. We believe a focus on delivering the best care at the right time yields the best medical results, including fewer complications, and better clinical results. With better medical outcomes achieved, higher return to work rates and lower long term costs follow. That's a win-win for the patient and the payor.

Immediately following a referral, Paradigm’s Care Management Team (Director of Clinical Services, nurse case manager, Medical Director and others) thoroughly assesses the injured person’s status and determines, through consultations with the attending clinical team, what resources are anticipated for the injured person to achieve his/her maximum functional outcome. Paradigm then compares this information to data gathered on other similar cases and discusses the findings.

The Care Management Team outlines current clinical problems in detail. Then, based on their experience, they determine the associated resources needed for the injured person’s treatment. The team also outlines the clinical risks that may impact the overall resources needed to fully address the injured person’s recovery. Finally, Paradigm delivers a contract for the client’s acceptance.

As the case progresses, all parties identified as requiring clinical updates will receive direct communication from the Paradigm nurse case manager. In the case of acute catastrophic injuries, this will occur within 24 hours of completing the initial onsite assessment. Following this initial assessment, Paradigm will provide weekly updates until the contract, called an Outcome Plan, is accepted. After the plan is accepted, Paradigm sends monthly reports with additional communication.

A similar process is followed for legacy cases (complex large loss and pain management cases). The main difference is in the way we structure contracts. Instead of individual case level guarantees of medical outcomes, these guarantees are provided at the portfolio level.