11/03/2009
CONCORD, CA – November 4, 2009 – Paradigm Management Services today introduced a new medical management program for cases with persisting conditions stemming from catastrophic and complex injuries. Unlike traditional approaches to claims with ongoing volatility, the Complex Large Loss Plan uniquely quantifies the financial savings and functional improvements, guarantees performance, and assumes the risk for a client’s entire claim portfolio.
“Our clients often ask for help managing cases beyond the acute period of care, even years from the initial date of injury,” said Kevin Fleming, Paradigm’s President. “Naturally, they’re concerned by ongoing complications and expenses and feel like all they can do is adjust case reserves as needed. We listened and designed a new offering that lowers costs by ensuring the injured worker receives the right care. This approach gets to the root causes of legacy cases and proves its value.”
The Complex Large Loss Plan provides independent analysis and estimates by Milliman, Inc. of specific lifetime case reserves at the beginning and end of each contract. Recent analysis by Milliman indicated that Paradigm reduced lifetime medical costs and reserves by 29% for large loss claims during the multi-year pilot.
“I am not aware of any other analysis quantifying the lowering of case reserves via medical management for the types of catastrophic and complex injuries studied,” said Bob Briscoe, the senior Milliman claims consultant who conducted the analysis.
Built in medical impact scales make it easy to measure and quantify the functional improvements Paradigm achieves. The Complex Large Loss Plan also delivers customized performance guarantees based on specific portfolio characteristics.
The Complex Large Loss Plan’s risk-bearing contract structure transfers responsibility for paying all medical expenses to Paradigm for a specified period of time. This locks in a single rate, and eliminates financial volatility and medical cost inflation during the contract period.
Methodology & Eligibility
The Complex Large Loss Plan leverages Paradigm’s Systematic Care ManagementSM methodology to improve care, reduce volatility and manage costs in each case of a portfolio. A comprehensive medical, social, psychological and vocational course correction plan stabilizes and improves the injured worker’s condition. An expert Paradigm Medical Director, onsite nurse case manager and clinical management team oversee all aspects of care.
Cases eligible for the Complex Large Loss Plan exceed $15,000 per month in medical costs and project $500,000 or more in remaining lifetime costs. Paradigm’s performance managing these persisting conditions averages 50% improvement in physician costs, 28% improvement in attendant care costs and 22% improvement in pharmacy costs.
About Paradigm Management Services, LLC
Paradigm Management Services provides acute and ongoing catastrophic and complex case management services for traumatic brain injuries, spinal cord injuries, amputations, burns, wounds and chronic pain. As the nation’s leading provider of complex and catastrophic medical management in the workers’ compensation industry, Paradigm achieves 5x better medical outcomes and lowers total costs by 36%. Paradigm accomplishes this by bringing together nationally recognized doctors and specialists, the best network of care facilities in the country, and nearly 20 years of clinical data to guide decisions. For more information, visit www.paradigmcorp.com.
