Public employees—including first responders, such as police officers and firefighters; and those who spend a significant amount of time driving—encounter high rates of catastrophic and severe injuries. When serving in the line of duty, these workers can face multiple trauma, vehicle-related injuries, burns, and gunshot wounds, among other life-altering injuries/diagnoses. Seriously injured public employees also frequently contend with a wide range of mental health and behavioral issues that must be addressed—including post-traumatic stress disorder, depression, anxiety, and insomnia.

With our specialization in catastrophic and severe injury management, Paradigm understands the critical need to keep injured workers at the absolute center of the care journey. Our HERO Catastrophic^SM and HERO Severe^SM Outcome Plans were created to deliver guaranteed outcomes for the most unpredictable and challenging cases, with medical risk transfer at a fixed cost.

This makes our proven care model uniquely equipped to support the needs of public entity employers with catastrophic and severe injury cases. For more than 30 years, we have helped numerous seriously injured public sector workers and their families achieve life-changing outcomes while delivering certainty and cost savings for public entity employers from the start.

Paradigm offers public employers:

• An easy claims referral process – There’s no risk and no cost to refer an injured worker.
• Efficiency and cost savings – We will work with your TPA and bill review partners to develop strategies that will allow our partnership to meet the emergent care needs of those with catastrophic and severe injuries.
• Speed of payments – We immediately begin making medical payments from the time of referral.

All of this is only possible through the rigorous, evidence-based, data-driven processes that we’ve implemented across more than 20,000 catastrophic cases. Every Paradigm Outcome Plan follows five essential steps to provide the highest levels of human-centered, outcomes-focused care for these extremely challenging injuries.

1. Personal engagement with the injured worker within 48 hours of referral by a nurse case manager with catastrophic injury training
Within the first two days of referral, a Paradigm Network Manager—an expertly trained catastrophic nurse case manager—will conduct an on-site assessment and initiate communication with all parties. This builds an immediate and meaningful connection with injured workers and their families and lays the groundwork for developing their trust and understanding of the challenges ahead.

From the time of the initial on-site, and on an ongoing basis, Paradigm Network Managers begin gathering pertinent medical records and communicating with the treatment providers. This holistic assessment gathers information about all aspects of an injured worker’s medical, functional, and psychosocial status. This allows the Paradigm Management Team to begin conceptualizing an individualized Outcome Plan, provide clear and updated information to carriers, and continue building a supportive, effective, and trusting relationship with the injured worker and their family.

2. Medical and behavioral health treatment plan developed by a dedicated and accountable team of experts
Paradigm Network Managers function as part of the full Paradigm Management Team. Typically within the first 21-30 days, this integrated team, which includes expert physicians and dedicated clinical specialists, coordinates early stages of care, develops projections regarding anticipated future treatment plans and cost estimates, and determines the target long-term functional outcome level.

The Paradigm Management Team also includes behavioral health professionals assigned to provide support, coping strategies, and resources to all injured workers and their families. This includes proactive assessment of psychosocial challenges and risks, and personalized care plans designed to promote positive psychosocial adjustment and address potential barriers to recovery.

The Paradigm Management Team integrates information gathered from the injured worker, their family and medical providers with their own specialized clinical expertise and Paradigm’s proprietary, data-informed analytics based on more than 20,000 cases and cost-containment solutions. This comprehensive approach results in a treatment plan that optimizes risk mitigation, promotes evidence-based care, and achieves optimal functional outcomes, while effectively managing costs.

3. Risk-bearing, guaranteed Outcome Plan is presented with a competitive fixed price
Around 30 days from referral, the clinical team will present a comprehensive, data-supported, and expert-driven Outcome Plan for client consideration. For public entities, Paradigm Outcome Plans deliver the following advantages:

• A fixed pricing model with medical risk transfer provides real value and lower lifetime medical costs to meet the needs of self-insured organizations. From the outset, clients can set accurate medical reserves and be confident that the case will achieve a guaranteed outcome, while eliminating the concerns of medical cost variability.
• Flexible contract and payment structures. Fixed pricing does not mean you pay the full contract price at once but allows for payments throughout the duration of the claim.
• Paradigm specializes in managing these extremely complicated and lengthy injuries, leaving time for your team to focus on driving the best outcomes for more of your higher-volume, lower-complexity cases.

When the road to recovery is uncertain and the injury requires multidisciplinary treatment, our clients are guaranteed a specific outcome at a fixed price.

4. Clinical management by experts to minimize anticipated medical and behavioral health risks and maximize functional recovery
Guaranteed outcomes means that Paradigm stays on the case until the injured worker completes their restorative rehabilitation and achieves their maximum recovery potential, typically nine to 24 months from referral. A consistent Paradigm Management Team provides clinical management throughout their active recovery course to minimize anticipated medical risks and maximize functional recovery.

We chart a pathway to Outcome Achievement with patient-specific milestones that are built into the care plan based on the specific diagnosis, severity of injuries, health projections, and recovery expectations. During this time, our clients receive regularly scheduled updates of the injured worker’s progress through functionally relevant and meaningful achievements that must be accomplished before the injured person is deemed to have reached their maximum functional outcome.

Paradigm provides access to the best network of quality providers, and experienced guidance for highly complex cases, which keeps the injured worker focused and motivated to chart a path to optimal recovery. Our high-quality national network supports the injured worker through access to the best possible providers, based on quality, expertise, and efficiency—all for the purpose of restoring the best possible life to the injured worker and their family.

5. Agreement of a guaranteed outcome with the client and confirmed by the treating physician
Paradigm Outcome Plans deliver a guaranteed outcome that is only complete when there is mutual agreement that the planned result has been achieved with the client and substantiated by documentation from the injured worker’s treating physician(s). Our ability to deliver these outcomes, with a focus on return to work for those with post-injury potential, includes a clear and committed focus on measuring and articulating our industry-leading outcomes. Paradigm’s clinical and analytical teams work together to identify and measure metrics for quality assurance and to ensure any claim made about outcomes is provable and comparable.

Proven Paradigm Outcomes benefiting public entities and injured workers include:

• 32% lower lifetime medical costs¹
• 40% of individuals return to gainful employment, nearly 6X higher compared to industry benchmarks¹
• 87% injured worker satisfaction²

The entire Paradigm team works every day to help these courageous heroes achieve their best possible recovery when the most serious injuries happen. Referring cases to Paradigm is easy—there’s no risk and no cost involved to see firsthand how we can partner with you to help achieve the best possible outcomes for these most challenging cases, in tandem with significant cost savings.

Sources:

1. Milliman Complex and Catastrophic Workers’ Compensation Claims Cost Analysis for Paradigm—October 2020
2. Paradigm case data, 2018-2022