The True Value of Better Outcomes: Certainty, Stability, Savings

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The True Value of Better Outcomes: Certainty, Stability, Savings
Working with a proven, specialized partner in catastrophic injury management delivers life-changing results for injured workers and their families—as well as immediate and long-term benefits for Paradigm clients.

The most serious injuries can destabilize organizations, just as they do the lives of injured workers. Catastrophic claims come with substantial risks and extreme cost volatility, particularly if opportunities to mitigate those risk factors are missed during the crucial early stages of treatment. Without focused guidance backed by years of experience and expertise dealing with such injuries, employers, plan administrators, and payers can be left with escalating long-term medical and indemnity costs, creating an unfavorable ripple effect across their business.

Selecting a partner with established, injury-specific expertise allows payers to successfully and confidently manage the complexities of these life-changing claims, while minimizing any negative impact on their business. For more than 30 years, clients have turned to Paradigm for a collaborative approach built on a proven model that delivers guaranteed results, lower lifetime claim costs, greater stability of financial results, and reserving confidence for these challenging cases. Above all, partners value Paradigm’s expertise in providing the best outcomes for catastrophically injured workers, in tandem with the needs and goals of their organization.

The Difference Between Experience and Expertise in Catastrophic Cases
For catastrophic injuries, stable and predictable claim costs are rooted in superior functional outcomes. Paradigm’s medical and behavioral health professionals supplement their knowledge with data from more than 20,000 catastrophic cases—and leverage a proven care model to provide a full spectrum of specialized support and guidance throughout the recovery journey.

For each HERO Catastrophic^® Outcome Plan, a multi-faceted team of specialists are hand-selected for the injury type and unique needs of the case. This team remains engaged until the guaranteed outcome is achieved, with full agreement from both our payer partner and the injured worker’s physician. With a robust lineup of specialized physicians, field-based nurses with unmatched catastrophic and injury-specific training, and behavioral health professionals to mitigate psychosocial recovery barriers—plus additional specialists as needed—each case receives the right mix of expertise to deliver optimal results.

Most Paradigm clients have their own medical teams or nurses—often with some experience in managing catastrophic cases—but the vast majority of their experience is often more generalized and focused on lower-severity or less complex cases. Working with Paradigm brings condition-specific expertise needed for their most severe cases, better positioning payers to properly resource and therefore better manage all their cases and support the needs of their stakeholders. “There is a difference between experience and expertise in catastrophic losses. We very much appreciate the catastrophic expertise that Paradigm is able to bring to the table,” says Gus R. Gonnella, Vice President, Claims Department, for the MEMIC Group. “They are an invaluable partner we trust to augment our managed care services.”

Paradigm clients benefit from and frequently comment on our ability to provide access to the highest quality of care from specialized care centers and leading rehabilitation facilities. This access is supported by peer-to-peer relationships with Paradigm Medical Directors and Network Managers, as well as mutual respect for the expertise and value-based incentives driving superior outcomes. By collaboratively engaging with leading rehabilitation centers, injured workers have the best chance of achieving optimal functional outcomes and avoiding costly setbacks.

Better Functional Outcomes = Better Financial Outcomes
Through the unique combination of clinical expertise and experience, Paradigm ensures injured workers and their families reach their best possible “new normal.” A key tenet of our mission is to restore hope when hope is most needed. This commitment contributes directly to Paradigm’s track record of superior, verifiable outcomes and their lasting impact on injured workers and clients.

Tangible business value for workers’ compensation payers
For clients, the delivery of exceptional functional outcomes translates to stability and significant financial savings for the life of the claim. Paradigm’s verified track record for durable care management enables stakeholders to make decisions with clarity, bringing predictability to the most volatile of cases. Ultimately, these are results that have a direct and significant positive impact on payers’ financial performance and their market competitiveness, allowing them to better deliver on the commitments to their clients.

Despite the many financial complexities and uncertainties, it’s a simple equation. When catastrophically injured workers have a better outcome, lifetime claim savings are significant.

By ensuring injured workers receive the quality care needed to maximize functional independence and a more likely release to return to work, Paradigm helps partners reduce medical and indemnity spend on preventable complications, pharmaceuticals, and long-term disability. “These cases are going to be long-term cases. Even after they reach Outcome Achievement, they’re still going to have some long-term care needs. Often, these cases will have significant pain management needs and medications accounting for as high as 50% of the medical spend—we don’t see that when Paradigm is involved,” explains Gonnella.

Achieving stable results for the most volatile claims also contributes to financial flexibility and efficiency for stakeholders. Thanks to the durability of our outcomes, which reduce hospital readmissions and fewer in-home care needs, Paradigm clients are better positioned to make quicker and more accurate reserve decisions and claim settlements.

Quality care for injured workers and the resulting financial savings have positive ripple effects. Clients point to a range of benefits, including increased operational efficiency, adjuster retention, and reduced litigation. By working with Paradigm on catastrophic cases, insurers, plan administrators, and self-insured employers can free up resources to be proactive on other claims, improving outcomes and providing more value to their stakeholders.

Paradigm clients share a commitment to achieving better outcomes based on the understanding that doing the right thing by injured workers ultimately leads to superior results by all measures, including financial. “We appreciate Paradigm’s customer-centric approach that gets the best outcomes in a compassionate way—MEMIC’s culture is comparable in that way,” says Gonnella. A collaborative partnership with Paradigm brings to the table a care manager that has a proven track record for superior outcomes; not only improving the lives of injured workers and their families, but also contributing to the long-term stability and success of our partners.

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

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.