Catastrophic workplace injuries represent the most life-altering and expensive cases in workers’ compensation. Because of the high level of care that these injured workers need, the average catastrophic claim can typically be in the millions of dollars. More importantly, catastrophic injuries fundamentally impact injured workers, their families, and communities. They also create unparalleled challenges for returning to work, restoring basic functions, and reentering the community.

To successfully overcome these challenges, Paradigm’s proven outcome plan model requires a focused approach with specialized expertise. The Paradigm Systematic Care Management^SM model incorporates these key aspects into every step of the care process. It is carefully designed to help ensure successful long-term outcomes.

Case management is an important component of the Paradigm Outcome Plan. Beyond that, it also takes a deep support network to achieve positive results. The Paradigm model has been carefully built over three decades to deliver comprehensive care and industry-leading outcomes. The following are five of the essential elements that set the Paradigm Outcome Plan apart from traditional case management models.

1. Highly specialized nurses and day-one behavioral health support
Paradigm Network Managers are highly skilled nurse case managers who are carefully selected and trained to handle the needs of catastrophically injured workers and their families. The long-term care needs for cases that include burns, amputations, and brain injuries require clinicians who can navigate the complex array of treatment providers. Our network managers have industry-leading experience and training, as well as unmatched catastrophic case management skills.

Because patients are often incapacitated as a result of their injuries, our nurses know how to work with family members. In the process, they often need to overcome communication barriers and address behavioral health concerns that are unique to catastrophic care. This is why from day one, a dedicated Paradigm Community Support Specialist is assigned to each case to help overcome psychosocial obstacles to recovery. By actively identifying resources across a broad spectrum of needs, we help injured workers and their families receive the whole-person care they need to thrive.

2. Clinical expertise—a Paradigm Medical Director is assigned to every case
Supporting each network manager is a Paradigm Medical Director who is an experienced physician with a specialized clinical background in specific injury categories. Together, they work to coordinate care and support recovery. They do this by applying their vast experience and leveraging proprietary data from more than 17,000 completed Paradigm catastrophic cases.

As part of the Paradigm Management Team, our physicians regularly interface with treating providers. In addition, clinical and behavioral health specialists are part of every team, including Paradigm Directors of Clinical Services, Community Support Specialists, and Network Managers. In every case, the primary goal is to connect injured workers and their families with the most experienced specialists and facilities available to treat the exceptionally complex injury.

3. Powerful partnerships with leading providers
We have spent decades curating our Catastrophic Specialty Network®. It consists of leading providers of catastrophic rehabilitation and care delivery who strive to facilitate the best clinical outcomes. We integrate these provider partners into our outcome plans from the very beginning to help ensure seamless transitions of care.

Through each outcome plan, we hold providers accountable to the same high standards we set for ourselves. Our focus is on ensuring uncompromised treatment that truly achieves life-changing results. With our value-based and outcomes-focused approach, that means doing whatever is necessary—even if it means traveling to a rehabilitation hospital or specialist across the country.

4. Guaranteed outcomes and increased return-to-work rates
For each individual whose case we manage, Paradigm establishes an upfront guaranteed maximum functional outcome. Our individualized outcome plans are designed to get injured workers back into their community and back to work. Despite the often low expectations for returning to work in catastrophic cases, Paradigm has return-to-work rates that are nearly six times higher than industry benchmarks.

This statistic is backed by a 2020 independent study from a leading actuarial firm. And it’s consistent with results from studies conducted in 2008 and 2013. The 2020 report showed that among Paradigm cases, 65% of patients were released to return to work, and of those, 40% did. Paradigm Outcome Plans are carefully developed to achieve the best possible results—and have been consistently doing so for decades.

5. Financial certainty and value for the best possible outcome
Our fixed-cost outcome plan includes all compensable medical costs from the date of the injury until the guaranteed outcome is achieved. We relieve clients of all of the risk with our fixed-price and whole-person approach to recovery. With Paradigm, everyone involved is assured that every clinical, psychological, and social need will be addressed.

Paradigm is dedicated to delivering financial certainty and value. According to the 2020 independent study, Paradigm consistently achieves lifetime medical savings of 32%, compared to industry benchmarks.

Learn more about Paradigm’s unparalleled approach to catastrophic care management and guaranteed outcome plans that restore hope and change lives.