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State: Ntl. Paduda: The Cost/Benefit of Catastrophic Case Management: [2021-03-23] |
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A well-designed, thorough and much-needed study of the impact of nurse case management on catastrophic claims was completed late last year by the University of Washington. The UW study examined 216 cat cases insured by L&I, the state workers’ compensation fund, and evaluated workers' satisfaction and self-reported outcomes, duration of time loss and total medical costs. Among the conclusions were these:
One particularly striking conclusion was the economic analysis. The analysis “examined the predicted and actual medical and NCM costs for one outcome-based firm with the most referrals (Paradigm).” Of the 216 cases, there were a total of 25 referrals to Paradigm, of which 15 were accepted by L&I and managed by Paradigm. The report noted that the small number of Paradigm cases precluded a formal “statistical assessment or economic evaluation, e.g., return on investment (ROI) analysis.” Instead, the UW researchers provided a “descriptive analysis involving comparisons of different cost measures in order to assess the economic value of NCM services provided by Paradigm.” Regarding the Paradigm cases, the study concluded:
I reached out to Paradigm to get its take. This is the response:
I followed up with this request:
Paradigm responded:
Three observations First, the 24-month time period may well have been too short to capture the full impact of Paradigm’s program. Second, the cost of case management services strikes me as “valid” indeed, if one is concerned about the total cost of a cat case. I cannot imagine a scenario where a VP of claims or medical director wouldn’t have some rather pointed questions about a cat case where case management costs were almost double medical expenses. Third, Paradigm predicted medical costs that were much higher than what L&I actually paid. Disclosures Carisk is a Health Strategies Associates consulting client. It has a division that competes with Paradigm Outcomes. I’m working with two of the researchers on a PCORI-funded analysis of the impact of different regulatory approaches on opioid prescribing in workers’ compensation. Note: For more of my coverage of Paradigm, check my posts complimenting the company on its strategy and suggesting more payers should utilize its services. Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog. |