Work-related injuries affect more than 4 million people each year, resulting in upwards of $30 billion in spending.¹ Although there are key differences between the workers’ compensation and general health systems—particularly with respect to state-mandated treatment guidelines and fee structures—injured workers are still patients with the same underlying health needs. And for cases that very often require specialized treatment, access to high-quality specialty providers will always be a common denominator for optimal outcomes.

By directing injured workers to the right provider for each unique situation, workers’ compensation specialty networks fulfill a crucial function, while bringing value to employers, plan administrators, and payers. Specialty networks prioritize access to a wider range of services, and consist of highly qualified specialists providing in-depth expertise for specific conditions. A well-designed, high-functioning nationwide specialty network based on deep provider relationships and durable contracts can be essential to reducing the complexity, length, and cost of cases that require specialized treatment.

Specifically, specialty networks rooted in targeted network development, best-in-class credentialing, and end-to-end support are best positioned to deliver positive outcomes for workers, while ensuring optimal value for payers. A network with the capabilities to proactively refer injured workers to the best possible medical provider for their specific needs will ultimately build trust and improve outcomes for everyone involved.

Targeted network development—the foundation of quality
Because a provider network is only as effective as the providers that belong to it, attracting the best and most appropriate care providers requires a focused development strategy. To support long-term expansion, quality networks must be able to leverage external, industry-specific source analytics and proprietary data to help ensure targeted identification and network inclusion of providers that meet rigorously defined standards for quality, cost, and performance. Specifically, Paradigm Specialty Networks is built to recruit providers that can consistently achieve superior clinical outcomes and efficiency, is available and accessible to patients, and offers responsive communication—all in accordance with externally sourced provider benchmarks for national quality scoring.

A balanced and diverse mix of specialties is also crucial. Dedicated workers’ compensation specialty network members need a clear understanding of the specific injuries and their rates of occurrence. Paradigm Specialty Networks includes providers specializing in pain management, orthopedic and spine care, and post-acute care to direct injured workers to comprehensive treatment for the most frequent and challenging injury classes.

Credentialing management that transcends industry standards
Provider credentialing is critical to workers’ compensation specialty networks, ensuring providers and facilities deliver effective care that is in line with established standards for patient safety, experience, and outcomes. In addition to being in full compliance with guidelines from the National Committee for Quality Assurance (NCQA), Paradigm has undertaken multiple key credentialing initiatives to go above these standards, including working with third-party vendors to verify selections and perform ongoing provider monitoring.

Paradigm also leverages an internal credentialing committee consisting of three independent physicians who meet regularly to review actionable items, such as urgent credentialing requests and pending sanctions, and evaluate prospective providers. And to fully validate the highest levels of credentialing compliance, each network is subjected to rigorous annual client audits.

Full end-to-end administrative support and durable provider relationships—the final key to access and quality
True high-value specialty networks need to do more than deliver provider access. Payers and employers also require administrative support to achieve the outcomes injured workers deserve, while effectively managing spend. A comprehensive approach eases administrative burdens for payers and providers, enabling maximum emphasis on quality care.

Strong provider relationships based on credible interactions and durable contracts are also essential to quality and value. This is why Paradigm Specialty Networks offers the only directly managed model. By providing full-service management, Paradigm acts directly as the payer and as a single point of communication for all stakeholders. Relationships built on clear contracts and communication promote prompt provider payments, reduced reconsideration requests, and more stable rate structures.

Ultimately, specialty networks can play an essential role in delivering reasonable and equitable prices for medical goods and services as well as a smoother, more positive experience for both providers and injured workers. As an example, Paradigm’s Orthopedic & Spine Network refers cases to ambulatory surgery centers instead of hospitals whenever appropriate—containing costs, while promoting injured worker satisfaction and positive functional outcomes. Paradigm Specialty Networks has the capability to balance adequate compensation for providers, broad accessibility for injured workers, and optimal value for payers.

Redefining quality and outcomes in workers’ compensation specialty networks
Compared to broader-based network models, specialty networks are uniquely positioned to deliver the highest-quality treatment for injuries requiring specialized care. In this critical segment, Paradigm is the established leader in high-value outcomes. By combining industry-leading provider selection standards with an unmatched model of direct, full-service network management in tandem with highly competitive rates, this specialty network approach aligns with Paradigm’s commitment to more beneficial outcomes for injured workers and a focus on value for payers.

Targeted network development, nationwide coverage, the highest level of credentialing, and full administrative support with durable contracts come together to help clients and injured workers benefit from improved recovery outcomes and premier cost management.

Learn more about Paradigm Specialty Networks and our unmatched commitment to quality.

Sources

1. Paradigm internal data