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Full article on reduceyourworkerscomp.com
Background
Alexander, a structural engineer, was inspecting an industrial worksite when a portion of the roof collapsed and he fell 35 feet to the ground, sustaining life-threatening brain and multiple trauma injuries. With the help of his Paradigm Management Team, Alexander and his family received the level of medical and behavioral health care necessary to overcome an almost unimaginable catastrophic injury.
10/26/2020: Date of injury – case referred to Paradigm
Upon injury, Alexander was immediately transported to the hospital for emergency treatment, where doctors diagnosed a severe traumatic brain injury and multiple trauma injuries, including spinal and facial fractures, among other injuries.
The next day, Alexander’s employer and their insurance carrier took steps to refer the case to Paradigm. A Paradigm Network Manager—a specially-trained and experienced nurse who provides on-the-ground support and coordination for the injured worker, the family, and care providers—conducted an initial on-site assessment of Alexander’s medical, functional, and psychosocial status. The Network Manager also ensured that Alexander’s wife Licia was getting the support and information she needed while Alexander was in a medically induced coma.
Client impact: As the carrier’s long-standing partner for catastrophic cases, very severe and complex workplace injuries like Alexander’s are sent to Paradigm for full assessment and review in consideration of a Paradigm HERO Catastrophic® Outcome Plan. Once a referral is received, a full Paradigm Management Team is assigned, based on the injuries and needs of the case.
10/27/2020 – 12/7/2020: Treatment plan developed by the Paradigm Management Team and risk-bearing, guaranteed HERO Catastrophic Outcome Plan was presented
During the acute care phase, Alexander required multiple orthopedic procedures to address his injuries, and experienced serious complications, including acute respiratory failure, anemia, and a cerebrospinal fluid leak. Alexander’s Network Manager ensured that he and Licia received continual updates and in-depth education as part of a carefully selected team of experts assigned based on his care needs. Alexander’s Paradigm Management Team worked to assess his care needs and developed a comprehensive care plan.
From left to right, key clinical members of Alexander’s Paradigm Management Team:
- Network Manager: Carol Sears, BSN, CCM, CDMS – A local nurse with comprehensive catastrophic injury training, Carol provided face-to-face support and coordination as the primary liaison for Alexander and his wife.
- Director of Clinical Services: Sheila Bennion, RN, CCM – With experience as an on-site nurse case manager and 25 years working for an insurance carrier, Sheila was chosen to lead the team, based on her expertise in catastrophic care management and her ability to assure alignment with the carrier.
- Medical Director: Richard Adams, MD – As a brain injury specialist, Dr. Adams partnered with two other Paradigm Medical Directors—a trauma orthopedic specialist and an ocular plastic reconstructive facial specialist—to ensure comprehensive and consistent care and coordination with the treating providers.
| “Our case manager, Carol, has been a blessing to our lives. Without the intervention of the case manager and Paradigm, by myself I couldn’t help him the way I wish I could.” – Licia Borges, Alexander’s spouse |
Client impact: Alexander’s Paradigm Management Team presented the contract to the insurance carrier, which included a guaranteed outcome, and then reviewed the expert-driven care plan. This was the highest level of case severity that Paradigm manages.
12/7/2020 – 2/24/2023: Expert clinical management minimized medical and behavioral health risks and maximized functional recovery
Alexander’s Paradigm Management Team advocated for his transfer to the Shepherd Center in Atlanta, GA, a regional Center of Excellence for neurological and physical rehabilitation. His Management Team coordinated a seamless transfer of care and even assigned an additional Network Manager in the Atlanta area so that Alexander and his wife still received in-person support during his rehab. In addition to physical care, Alexander received comprehensive neurological, behavioral, and psychological support while at Shepherd.
After completing rehabilitation, Alexander was transferred to his home, where he participated in outpatient physical, occupational, and speech therapies. Following subsequent surgeries to his ankle and elbow, his surgical wounds healed without signs of infection or complications. Alexander and his family received training in care protocols and ongoing behavioral support that included a Spanish-speaking psychologist. He was also taught strategies to manage cognitive challenges, including minimizing environmental distractions and limiting multitasking.
Client impact: Based on our long history of working together, there is a structured process in place for the carrier to receive clinical and financial reports, including information on life expectancy and lifetime medical costs to influence medical reserve planning.
2/24/2023: Mutual agreement with the client that Alexander had reached the guaranteed outcome
Alexander was released to return to work full-time with light physical duty and the provision to attend ongoing therapies and physician follow-up visits. Alexander’s employer accommodated his work restrictions, and he returned to work in May 2021 to his pre-injury position.
More than 20 months after his return to work, Alexander completed restorative therapy from subsequent surgeries and achieved the guaranteed outcome contracted in the Paradigm Outcome Plan. He also had a long-term management plan in place for his continued success.
| “It is important to have people that help you. It’s something that you can’t do alone. And for me, that was amazing, that I got this help from Paradigm.” – Alexander Borges, Injured Worker |
Client impact: Alexander was considered to have met the guaranteed outcome contracted in the Paradigm Outcome Plan only when there was mutual agreement with the client. Upon plan completion, the client received a Paradigm Outcome Achievement Report and a Lifetime Medical Cost Estimate, based on Paradigm’s proprietary data, to support accurate reserves.
The Paradigm Outcome
Today, Alexander lives at home with his family, drives a modified vehicle, and has returned full-time to his intellectually demanding, pre-injury role as a structural engineer. Having achieved successful residential and community reintegration, Alexander appreciates the time he can spend with his family and his ability to work and perform daily tasks independently.
Watch the video of Alexander’s and his family’s inspiring recovery story:
Speak to our team of experts: Connect with Paradigm and let us bring certainty to your most uncertain cases.
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