Background
While on duty, police officer James “Jamie” Nance was in a motorcycle accident that caused complete spinal cord injury and multiple trauma. His Paradigm Management Team guided Jamie and his family through a 28-month rehabilitation, including 13 days in the ICU, six major surgeries, inpatient rehabilitation, outpatient therapy, home care, and 38 medical appointments. During this time, Jamie and the Paradigm team also navigated pain management and opioid weaning, the COVID-19 pandemic, the 2020 California wildfires, home and vehicle modifications, and a successful adjustment to his new “normal.”
08/28/2018: Date of injury – case referred to Paradigm
After seeing a news report about Officer Nance, the City of Stockton was contacted by their insurance carrier with the no-risk, no-cost recommendation to refer the case to Paradigm.
Jamie was treated in the trauma room for spinal cord injury, chest trauma, lung contusions, and a tibial/fibular fracture before being transferred to UC Davis Medical Center. A Paradigm Network Manager―a nurse expertly trained in catastrophic care―was immediately assigned to conduct an initial on-site assessment of Jamie’s medical, functional, and psychosocial status.
Employer impact: Paradigm began paying medical bills immediately upon referral. No RFP was necessary.
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“They are nurse case managers and experts in their field assigned to assure Mr. Nance gets the best medical care with the best medical specialists in the field. They are here to troubleshoot and push medical navigation so there are no delays or obstacles to expert medical care. When the family meets them, they will quickly see that these are ‘no-nonsense’ experts that move mountains to get the right care by the right specialist at the right time. “I look forward to giving you the back story to how this company came into being sometime. It’s truly extraordinary and phenomenal.” Karen Roberts, TPA Claims Examiner |
08/30/2018 – 10/04/2018: Treatment plan developed by the Paradigm Management Team and risk-bearing, guaranteed HERO Catastrophic® Outcome Plan was presented
Jamie’s dedicated Paradigm Management Team was assembled―a consistent group of leading clinical experts with injury-specific experience and comprehensive training who develop and execute the care plan. Jamie underwent spinal stabilization surgery with the support of his personalized team, whose members stayed on the case throughout Jamie’s recovery:
Employer impact: The City of Stockton facilitated a meeting with the Vice President of the Police Union to introduce Paradigm and the Network Manager to the Nances. The Paradigm Management Team helped the City’s Risk Manager prepare for a presentation to the City Council, which approved the contract at a fixed price, enabling the City to set their reserves and transfer the medical risk to Paradigm.
10/09/2018 – 12/21/2020: Expert clinical management minimized medical and behavioral health risks and maximized functional recovery
During the next two-plus years, Jamie’s Paradigm Medical Director communicated with treating providers. Jamie’s Paradigm Network Manager attended appointments to advocate for Jamie—and to educate him and his wife about his injuries, recovery, and treatment plan.
Paradigm provided access to a top-quality network of providers and rehabilitation programs, facilitating Jamie’s recovery throughout multiple surgeries and risks that manifested. When Jamie developed a pulmonary embolism, Paradigm’s Management Team took a proactive approach to seek treatment, resulting in a positive outcome for a potentially fatal condition.
The year 2020 presented additional challenges for Jamie and his family. His Paradigm Network Manager provided education, support, resources, and reinforced CDC guidelines to reduce Jamie’s risk of exposure to COVID-19—and later that year, ensured necessary medications, medical supplies, and DME were ready to mobilize when wildfires threatened evacuation.
Employer impact: Paradigm provided the City of Stockton with regular clinical updates on Jamie’s progress and achievement of milestone goals.
12/21/2020: Mutual agreement with the City of Stockton that Jamie had reached the guaranteed outcome
Jamie participated in a full range of community-based therapy services, proving his capacity to manage his needs in the community with minimal physical limitations from the wheelchair level. Paradigm and treating physicians confirmed Jamie had met the guaranteed outcome contracted in the Paradigm Outcome Plan, had a long-term management plan in place, and verified agreement with the City of Stockton. Jamie’s Paradigm Management Team closed the case and notified treating providers of the change in billing and the assured transition of pharmacy benefits.
Employer impact: Upon plan completion, the City of Stockton received a Paradigm Outcome Achievement Report and a Lifetime Medical Cost Estimate, based on Paradigm’s proprietary data, to support accurate reserves.
The Paradigm Outcome
Today, Jamie is retired from the police force and lives an active and independent life. He has all the necessary durable medical equipment provided by Paradigm and permanent home and vehicle modifications provided by the City of Stockton. He’s active with his family, has traveled long distance by air, and has taken a cruise. He participates in a wide range of interests and is active in his community and foundation.
Click here to learn more about how Paradigm provides superior outcomes for public employees and certainty for public employers.
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