A Value-Based Solution to Disrupt a Fee-for-Service System

Business Insurance
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Musculoskeletal (MSK) injuries have become a major category for suboptimal outcomes and rising costs in workers’ compensation. Too frequently, what should be a routine shoulder, knee, or back diagnosis develops into a large loss with delayed return to work. Of the $20 billion spent annually on work-related MSK claims,¹ these more volatile outlier cases represent a significant portion of medical, indemnity, and administrative costs.

In the current workers’ compensation system, injured workers, providers, and payers navigate a fragmented, misaligned fee-for-service framework that can derail recovery. Primary and ancillary providers are incentivized to focus on providing more treatment interventions and spending an outsized amount of time on medical documentation to optimize reimbursement. This misalignment takes the focus away from high-value patient care.

“Overstrained providers are drowning in administrative burdens and under great pressure to treat higher volumes of care faster, while injured patients struggle through a siloed industry that prioritizes activity over outcomes,” says Michael Choo, MD, Chief Medical Officer, Workers’ Compensation, Paradigm. “For MSK injuries, we need value-based solutions that fundamentally address this disjointed status quo.”

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