Paradigm’s Superior Catastrophic Outcomes Validated by Independent Study

Business Insurance
Author: Kevin Turner

Catastrophic injuries in workers’ compensation can change lives in an instant for workers, their families, communities, and employers. When workers experience a catastrophic injury, they face an overwhelming set of stressors: multiple, complex treatments; a lengthy recovery period; the emotional toll on themselves and their family; and the possibility that they will not be able to return to productive work. For employers, the loss of an employee and its impact on the worker’s family and coworkers can be severe. Through Paradigm’s 30-year industry experience, clinical expertise, and unique Systematic Care Management^SM model, Paradigm has proven that there is a way to deliver the best possible outcomes for all stakeholders.

New independent study validates Paradigm’s success
An October 2020 benchmark study¹  on catastrophic workers’ compensation injuries, conducted by an independent actuarial firm, identified measurable and significant differences in outcomes when Paradigm’s comprehensive approach is applied. For this study, catastrophic workers’ compensation injuries were defined as spinal cord, acute brain, multiple trauma, amputations, and burns that exceed $1 million in medical and indemnity costs.

The study analyzed outcomes against nearly 600 Paradigm catastrophic injury claims. It found that Paradigm’s medical and psychosocial management achieved 32% lower lifetime medical costs when compared with industry-standard claim practices. Notably, the savings Paradigm generated in catastrophic injury cases was consistent across injury type, complexity, age, jurisdiction, and location.

Return to work results are nearly six times higher than the industry
The benchmark study observed that in 65% of these claims, Paradigm was able to obtain a release to return to work for the injured worker. Of those, 40% actually returned to work, compared with an industry average of less than 7% – almost six times higher than the industry benchmark.

The report also considered the results of Paradigm’s approach on catastrophic injury claims in rural versus urban health care settings. Paradigm achieved 39% savings in total medical incurred costs over industry standard practices in rural settings and 31% savings in urban locations. This difference is significant, because rural communities typically lack the clinical and rehabilitation resources found in urban areas, the study noted. Systematic Care Management considers the location of the injured worker and the availability of medical resources in the community. In some instances, injured workers can travel to a handful of centers of excellence for post-rehabilitation care and other specialty clinical needs. However, travel and access to these centers of excellence is not always possible. In such instances, Paradigm works with the local medical facilities to assure the best level of care is provided and specialized health professionals are brought in, including therapists and other experts to work with local providers.

How Paradigm remains the industry leader in catastrophic care management
Paradigm’s Systematic Care Management approach puts injured workers and their families at the center of the outcome plan. Paradigm focuses on achieving the best functional recovery for the injured worker, while delivering financial certainty and predictable lifetime savings for its clients.

To achieve this, Paradigm bases its holistic approach on the following value points: 1) clinical and financial data; 2) specialized and coordinated care; and 3) risk mitigation.

Clinical and financial data
Paradigm’s three decades of deep proprietary data comes from managing more than 17,000 catastrophic cases. Paradigm conducts due diligence on each claim by collecting a robust set of data points to forecast the impact of medical factors, behavioral health, and family and community influences to identify and achieve the targeted outcome.

Specialized and coordinated care
Paradigm’s team of experts, unmatched in the industry, surrounds the injured worker and their family to provide them with expert, coordinated support. This team consists of a specialized physician, catastrophic-certified nurse case manager, clinical specialist, community support specialist, and director of clinical services – all working toward a long-term successful outcome for the injured worker. It’s this Paradigm expert team that allows Paradigm to take risk and guarantee outcomes.

Risk mitigation
For every case, Paradigm provides clients with a detailed roadmap to maximum functional recovery for a fixed price, within 30 days of Paradigm’s involvement in the claim. The client receives cost certainty for the recovery period, which can take years, and at conclusion, receives best line-of-sight on future liabilities. In addition, Paradigm’s work brings the injured worker and client together to reach a successful case trajectory after Paradigm’s involvement, be it settlement or ongoing supportive care. Either way, the injured worker is in the best possible position to continue forward.

Paradigm’s Systematic Care Management approach
The independent study verifies the success of Paradigm due to its laser focus on these outlier catastrophic injury cases, which represent a small percentage of total workers’ compensation claims, but account for a significant amount of the costs when they do occur. This focus results in Paradigm Catastrophic Care Management’s position as the industry leader in providing the best care possible for injured workers, with guaranteed financial outcomes for clients.

To learn more, click here to download a synopsis of the study or request a copy of the full Milliman study.

For more information, email catastrophic@paradigmcorp.com.

Kevin Turner is CEO of Catastrophic Care Management at Paradigm Corporation.

¹ Blais, A. (2020). Complex and Catastrophic Workers’ Compensation Claims Cost Analysis. Milliman.

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