Catastrophic and severe injuries can happen in any industry, to any business, and to any person, regardless of their role or job title. Although they are relatively rare—accounting for approximately three out of every 1,000 work-related injury cases—they bring tremendous uncertainty to the injured workers, families, businesses, and communities they affect.

Even for organizations with high-performing claims programs, these outlier injuries often drain time, resources, and money. Consequently, the ability to increase certainty in these cases can have a substantially positive impact on both financial and medical outcomes.

The uncertainty of catastrophic workplace injuries
Due to their randomness and complexity, in tandem with the long-term care and advanced technology they require, costs for the most serious workplace injuries are growing at a faster rate than overall medical spend.¹

Increasingly, these cases have the potential to become mega claims, too. In fact, there has been a 30% increase in catastrophic claims exceeding $10 million in the past three years alone.²

The complex nature of treating severe injuries such as burns, amputations, spinal cord injuries, and traumatic brain injuries requires an average of 60+ providers per case, long treatment windows, and an extremely high incidence of behavioral health issues. Catastrophically injured workers also have much higher rates of unforeseen developments that require the use of specialized facilities and advanced clinical resources.

For employers and plan administrators, a catastrophic or severe case brings immediate questions around setting accurate medical cost reserves and coordinating effective treatments.

While there is a chance that the injury and recovery will be less severe and less costly than anticipated, underestimating this risk increases the potential for years of cost overruns and recovery delays. In many situations, there is a very strong likelihood of paying out exorbitant medical claims, without achieving an optimal or even minimally satisfactory outcome.

Paradigm Outcome Plans: Bringing certainty to the most uncertain cases
Paradigm has been successfully navigating these uncertainties for more than 30 years with our Catastrophic Outcome Plans. Referring catastrophic cases to Paradigm means putting the most challenging cases in the hands of professionals with the knowledge, experience, and resources to deliver a guaranteed, certain outcome at a fixed price. To accomplish this, we have carefully designed our Outcome Plans to provide certainty for clients:

• Certainty of Medical Cost: Paradigm Outcome Plans are built on a fixed pricing model. The medical spend required to settle and close a catastrophic workers’ compensation case is an extreme variable. By leveraging our unparalleled library of data, knowledge, and clinical relationships needed to accurately calculate and predict costs, Paradigm Outcome Plans transfer medical risk away from our clients, delivering financial certainty. From the outset, our clients can set accurate medical reserves and be confident that the case will achieve a guaranteed outcome.
• Certainty of Outcome: The complexity of catastrophic cases makes it very difficult to know what to expect as the case progresses. Paradigm Outcome Plans deliver a guaranteed outcome that is completed when there is mutual agreement that the planned result has been achieved. We use an unparalleled repository of case data, the best provider relationships in the field of catastrophic care, and in-house clinical expertise to develop proven care pathways that achieve precisely measured, value-driven results.
• Certainty of Direction and Resources: Catastrophic cases drain time and resources, primarily because the path to recovery is highly complex and rarely straightforward. Paradigm has the experience to anticipate and address the long list of variables and unanticipated challenges that come with both catastrophic and severe injury care. Paradigm Management Teams work in close partnership with our clients, using decades of experience to find the best clinical path and the best medical partners to achieve an optimal outcome. This frees up internal client resources to focus on the more predictable and less severe workers’ compensation cases.

In short: Paradigm Outcome Plans deliver the outcome we promise, at the price offered, to restore the best possible life to injured workers and their families.

What happens when you refer a case to Paradigm
From day one, catastrophic and severe cases referred to Paradigm will receive a thorough assessment, followed by a contract designed for the specific needs of each client and injured worker. Cases warranting a fixed-cost Outcome Plan contract can expect a comprehensive plan detailing history, current status, future treatment plans, and outcome expectations. Upon achievement of all targeted outcomes, cases will receive lifetime medical cost estimates and an Outcome Achievement Report—a summary of the achieved outcomes, the patient’s current functional status, and any ongoing routine or maintenance-level supportive care needs.

Each case is handled by a Paradigm Network Manager who has undergone advanced, injury-specific, multiphase training programs for catastrophic care. Network Managers are backed by Paradigm Medical Directors—specialized physicians and diagnosticians matched to each worker’s injuries to ensure comprehensive and consistent care. To address the behavioral and psychosocial needs that are so often barriers to recovery, Community Support Specialists and specialized physicians are also available to assist on every case. Paradigm has built ongoing relationships with best-in-class providers, and we recommend facilities that are best suited to achieving optimal outcomes to meet the unique needs of the catastrophically injured workers we serve.

For clients, Paradigm will navigate the expected and unexpected risks that spring up during the contract period, meaning you will know exactly what you need to know, with no surprises. This commitment to certainty for our clients and life-changing outcomes for their injured workers shines through in our results. Against an industry benchmark of less than 7% of true catastrophic cases returning to work, we have achieved:³

• 65% release to return to work
• 40% return to gainful employment
• 32% lower lifetime medical costs

Learn more about our HERO Catastrophic^SM and HERO Severe^SM Outcome Plans and how to refer a case to Paradigm.

Sources:

1. Paradigm data, CMS.gov
2. Safety National claims data 3 years prior to 2023
3. Milliman Complex and Catastrophic Workers’ Compensation Claims Cost Analysis for Paradigm—October 2020