Risk & Insurance
Full article on riskandinsurance.com
By: Jeff Ziblut, Director of Post-Acute Care and Home Health, Paradigm
The post-acute care (PAC) phase is very often a key inflection point in workers’ compensation cases. Returning home after an acute care discharge is not always possible, particularly with serious or complex injuries. Diagnoses ranging from traumatic brain injuries to multiple trauma have elevated risks, including rehospitalization and reinjury, which can impact functional recovery, lengthen return-to-work times, and significantly increase costs.
When injured patients need continued support in the form of physical rehabilitation, occupational therapy, speech therapy, or skilled nursing, PAC is a bridge from the hospital to home. But during this critical interval, timing is everything. Claims management stakeholders have a very short window to assess treatment needs and select an appropriate facility. Factors including proximity, patient and family preference, and contractual agreements have the potential to prolong recovery, reduce functional outcomes, decrease patient engagement and satisfaction levels, and drive costs upward.
A dedicated, expertly managed PAC network with focused capabilities, expertise, data, and resources can guide this critical transition, all while maintaining fiscal responsibility. The Paradigm Post-Acute Care Network brings together timely access to care, superior communication, and hands-on care coordination to achieve one goal—deliver the right care at the right time to benefit injured workers, their families, and their employers.
Superior communication capabilities for increased patient satisfaction
Communication ties all of the components of successful care together. Breakdowns in communication can hinder recovery at any phase, especially during post-acute care. Keeping injured workers and clients informed of updates, while gaining insight into their experiences and new developments, keeps treatment on track.
The Paradigm PAC Network facilitates proprietary, patient-centric technology through CareLink, a cloud-based, HIPAA-compliant platform that allows for patient messaging and provides 100% transparency and visibility into claims. Integrated patient engagement through a simple text-based option facilitates participation and provides valuable information on the patient experience. Should a higher level of communication and visibility be required, the CareLink TeleConnect feature facilitates secure two-way video communication via smart devices. The result is high patient engagement and patient satisfaction levels, including a 72% opt-in rate for text-based communication and a 97% satisfaction rate.
Data-driven facility selection
When selecting facilities, post-acute care networks need to effectively align quality and opportunity. This calls for a wide network to ensure a nearby facility for any injury, and a selective network to deliver positive clinical and financial outcomes. Using advanced analysis and proprietary data, Paradigm identifies the highest-quality PAC providers for each geographic market, while avoiding oversaturation of facilities to achieve a diverse, high-quality, multi-specialty provider configuration at compelling rates.
PAC centers of excellence
Centers of excellence are PAC facilities specializing in patient-centered, diagnosis-specific care that integrates the latest research and treatment approaches. Injured workers and claims stakeholders deserve to know they are being referred to a facility that consistently exceeds service standards and delivers expert care. Superior PAC networks should consist of top-rated providers and offer an integrated, consistent approach that fosters successful transition to the home. Facilities in the Paradigm Network receive accreditation from best practice initiative organizations, including the Agency for Health Care Administration (AHCA), the Commission on Accreditation of Rehabilitation Facilities (CARF), and The Joint Commission. Every provider also receives industry-leading onboarding from Paradigm to ensure a consistent approach.
Hands-on care coordination
A quality post-acute care experience continues beyond initial facility selection, referral, and patient communication. Instead of simply offering access to a network, PAC solutions need to offer ongoing expert care coordination and support. Paradigm’s experienced Care Coordinators are carefully trained to match injured workers to the appropriate facility to ensure the right care, at the right level, at the right time.
The Paradigm Care Coordination process in action:
1. Hospital to post-acute care
- Identifying the most appropriate facility
- Negotiating rates if needed
- Coordinating discharge from the hospital
- Communicating the process clearly to all parties
2. PAC coordination management
- Monitoring care to ensure ongoing quality
- Identifying potential recovery barriers
- Providing weekly updates to all parties
- Conducting concurrent reviews of treatment progress
3. Discharge management
- Determining and designing a home care plan
- Overseeing the discharge plan
- Communicating dates and coordinating ancillary needs with all parties
A commitment to value
In addition to quality, PAC networks need to leverage experience and data to ensure competitive rates for clients—and Paradigm delivers savings significantly below standard jurisdictional allowances. Paradigm contracts ensure all parties know the costs involved, helping to achieve unit savings 15–30% below fee schedule or usual and customary allowances.
The Paradigm difference
Paradigm believes in the best possible PAC outcomes for injured workers, families, and employers. We match each case with the right facility for optimal recovery, value, and cost savings. Through a proprietary network of 6,600 skilled nursing, inpatient rehabilitation, assisted living, home health, and long-term acute care facilities, our specially trained, dedicated Care Coordinators provide hands-on, end-to-end management.
For Paradigm clients, the right care at the right time means:
- Integrated patient communication and engagement
- Credentialed providers and facilities nationwide
- Time-sensitive, multidisciplinary care coordination
- Accurate placement by injury type and severity
- Ongoing care plan assessment and validation
- Streamlined referral and payment processing
Better outcomes and cost savings have set Paradigm apart for three decades. Developed from the same DNA, our Post-Acute Care Network continues this standard.
About Paradigm
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business, including its risk-based clinical solutions, case management services, high-value specialty networks, home health, and payment integrity programs. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.
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