The Outcomes Our Heroes Deserve

WCI360.com
Full article on wci360.com

Overview
Public entity employees face an increased risk of catastrophic injuries that require expert management to contain costs and optimize recovery outcomes. As a care management organization with decades of specialized experience, Paradigm is uniquely positioned to solve the challenges of public entities and the complexity of life-altering injuries. Paradigm HERO Catastrophic® Outcome Plans are designed to deliver: immediate engagement with a specially trained nurse case manager, a data-driven medical and behavioral health treatment plan, a risk-bearing fixed-price model, expert clinical management, and guaranteed, mutually agreed-upon outcomes. This care management model has a proven record of verified results, including 32% lower lifetime medical costs and six times higher return to meaningful employment compared to industry benchmarks.

The Outcomes Our Heroes Deserve

Public entity employees—especially first responders—face extremely high catastrophic injury risk while in the line of duty. From police officers to firefighters to powerline workers, injuries such as multiple trauma, burns, and gunshot wounds are just some of the very real dangers that come with these critical jobs. Not only do these injured workers have substantial physical recovery needs, but they also frequently contend with mental health issues, including post-traumatic stress disorder, depression, and insomnia. And often, these unfortunate accidents draw public attention, so seeking the best possible solution for the injured worker and their family demonstrates a deep commitment to making the very best of a challenging situation.

For these high-stakes claims, successful recovery means keeping injured workers firmly at the center of the recovery journey. With more than 30 years of experience managing care for catastrophically injured workers and their families, Paradigm has become a trusted partner for achieving two very important goals: restoring the best possible life to the injured worker and their family and providing unmatched lifetime cost savings for our public entity partners.

How Paradigm serves public entities—the key elements of every Outcome Plan
Based on a rigorous, evidence-based, data-driven process derived from handling over 20,000 catastrophic cases, Paradigm HERO Catastrophic® Outcome Plans provide the highest levels of human-centered, outcomes-focused care for these extremely challenging injuries. When a public entity case is referred to Paradigm, here is what can be expected:

1. Immediate engagement by a nurse case manager with catastrophic injury training
Within one business day of referral, injured workers and their families receive on-site communication and assessment from an expertly trained catastrophic nurse case manager. Early engagement is essential for conceptualizing an individualized treatment plan; assuring the right care is in place; and most importantly, building a supportive, effective, and trusting relationship with the injured worker and their family.

2. A medical and behavioral health treatment plan—developed by a dedicated team of diagnosis-specific physicians and clinical specialists
Each case is fully supported by a team of experts, hand-selected for the specific conditions of the injury, who coordinate the early stages of care while developing treatment, cost, and outcome projections. Behavioral health professionals are also assigned to provide support, coping strategies, and resources designed to promote positive psychosocial adjustment and address potential barriers to recovery. This systematic approach to care management fosters evidence-based care, optimizes functional outcomes, mitigates risk, and effectively manages costs.

3. A fixed-price, risk-bearing, guaranteed outcome model
After a comprehensive analysis, the Paradigm clinical team presents a data-supported, expert-driven care management plan. Using a fixed pricing model with full medical risk transfer and a guaranteed outcome, Paradigm HERO Catastrophic Outcome Plans enable lower lifetime medical costs and earlier, more accurate reserve setting. The team answers questions and helps to prepare for authorization from boards or leadership with an approach that provides three key certainties for these most uncertain of cases—certainty of medical cost, certainty of resources and direction, and certainty of outcome.

4. Expert clinical management that minimizes risks and maximizes recovery
Due to the complexity and length of catastrophic cases, the Paradigm Management Team actively guides care to achieve a specifically targeted, incremental list of medical and behavioral health milestones on their path to maximum functional recovery. These patient-specific, functionally relevant, and meaningful achievements are built into the care plan, based on the injured worker’s diagnosis, severity of injuries, health projections, and recovery goals. Clients receive regularly scheduled updates to ensure everyone is aligned with the progression of care and planning for outcome achievement. A consistent management team, including specialized Paradigm Medical Directors, stays actively engaged throughout recovery to minimize risks, avoid surprises, and achieve the best outcome possible.

5. A guaranteed outcome, confirmed by the treating physician
Paradigm HERO Catastrophic Outcome Plans deliver a guaranteed outcome that is only complete when there is mutual agreement with the client that the guaranteed result has been achieved, substantiated by documentation from the injured worker’s treating physician. This commitment to verifiable results has built a long-term track record of proven Paradigm outcomes that deeply benefit the organizations and injured workers we serve:

We are committed to being an accountable, expert partner for the most challenging public entity cases, delivering life-changing outcomes, accurate reserving assistance, and significant lifetime medical cost savings. There is no cost or risk to refer a case to Paradigm. Come to us when the unthinkable happens, and we will help you find a solution.

Visit paradigmcorp.com/catastrophic to learn more about the value of HERO Catastrophic Outcome Plans.

Key Takeaways

• Public entity employees and first responders face an increased risk of catastrophic injuries.
• Catastrophic injuries are strongly associated with runaway costs and negative outcomes that destabilize public entities if not managed properly.
• Paradigm has a proven track record of managing these high-stakes cases that keep public employers out of the spotlight and injured workers on a path to successful recovery.
• Paradigm HERO Catastrophic Outcome Plans are carefully designed to achieve guaranteed outcomes through early engagement, clinical specialization, data-driven medical and behavioral care plans, and a fixed-price, risk-bearing model.
• This verified approach has a proven track record of superior outcomes, including medical cost savings, increased return to work, reduced hospital readmission rates, and reduced behavioral health needs.

Sources

1. Milliman Complex and Catastrophic Workers’ Compensation Claims Cost Analysis for Paradigm–October 2020.
2. Paradigm completed Outcome Plan contracts 2020-2024.
3. Paradigm durability metrics (one-year post-Outcome Achievement): completed Outcome Plan contracts, June 2020-November 2023.
4. Paradigm completed Outcome Plan contracts 2019-2023.
5. Paradigm case data, 2019-2023.