Paradigm is evolving rapidly, and none too soon. A data-driven firm known for taking risk on catastrophic claims, Paradigm has strengthened its behavioral health offerings and added case management, specialty and network services, all intended to make the company one of the major players in workers’ comp medical management.

Joe Paduda

I’ve tracked Paradigm for more than two decades, watching the company evolve from one stubbornly stuck in a business model that precluded growth to a diversified provider with a broad array of service offerings. In conversations with Paradigm execs several years ago, I wondered why the company wasn’t solving clients' problems, instead focusing narrowly on a highly selected group of catastrophic claims.

While this made sense from Paradigm’s perspective — it wanted to focus its expertise on a very select type of claim — there was a big problem with this approach.

Namely, Paradigm wasn’t thinking about this from its customers’ perspective. Customers gave Paradigm a big list of claims which it winnowed down; typically relatively few were actually “accepted” by Paradigm. The customer had a bunch of problematic claims, but Paradigm wasn’t interested in solving the customer’s problem; it just wanted to cherry-pick claims.

That’s changed.

I caught up with Paradigm Catastrophic Care Management CEO Kevin Turner a couple of weeks back to get updated on the company. Here are my takeaways (Paradigm Outcomes is one of three divisions).

Paradigm is moving down the severity scale, applying the expertise and experience it has gained handling big cat claims to less-complex claims. In so doing, the company is embedding itself deeper and broader into its clients — and growing revenues.

Turner spoke at length about Paradigm’s core asset — the wealth of data the company has amassed over the last three decades — and how that informs the company’s approach to managing cat and “near-cat” claims (my words, not his).

We also dove into biopsychosocial issues, including the patient’s “whole family situation” (again, my words) and the critical importance of the family in the recovery process. Marital status and satisfaction, financial stability and relations with children are all key considerations that can impact the recovery process. That just makes sense; if a patient has a difficult home life and kids with issues, it is going to be that much harder to get better.

The company recently launched a home-grown IT application — EDDG — designed to help care managers use the company’s historical data and lessons learned along with biopsychosocial indicators to manage claims.

Of note, Paradigm is no longer the only company in the cat claims risk-taking business. Carisk Partners has gained traction with its Pathways 2 Recovery program, leveraging the company’s deep expertise in behavioral health care and workers’ comp experience. Carisk takes risk both on individual claims and for entire portfolios of claims. (Disclosure; I work with Carisk.)

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.