Paradigm-sponsored Business Insurance Risk Perspective

An Innovative Partnership Sets the Standard for Value-Based Care in Workers' Comp

By Kathy Galia, Senior Vice President & General Manager, Clinical Solutions at Paradigm and Peggy Kirk, RN, Chief Operating Officer, Shirley Ryan AbilityLab

Value-based care is a concept that has been gaining traction for years in the workers' compensation field. With a value-based model, providers are focused on delivering the best possible outcomes for patients, collaborating early in the recovery process to avoid potential barriers, and improving health at both the individual and population levels while substantially lowering costs.

Accomplishing this requires providers and stakeholders to work closely together and set rigorous standards for best-care practices, based on evidence and patient data. As more organizations in workers' compensation look to adopt value-based models of care, success will also depend on innovative levels of collaboration in managing risk.

An essential element will be providers that are willing to assume responsibility and set outcome benchmarks from the outset of care. With a growing recognition of the need for positive functional—as well as behavioral—outcomes, it requires proactive and high quality providers to step forward. To establish value-based agreements, both parties need to align on outcome measures, have the data to validate performance, and be willing to bear financial risk for quality care.

Through a recently announced partnership between Paradigm and Shirley Ryan AbilityLab, two leaders in care for catastrophically injured workers have stepped up to redefine value-based care in workers' compensation. Together, both organizations will set new standards for accountability, transparency, outcomes, and holistic risk management that will benefit people facing the most challenging and expensive injuries in our industry.

Establishing a first-of-its-kind partnership required an elite provider

Catastrophic workplace injuries require the highest levels of care to achieve positive outcomes, and Paradigm has been successfully delivering results for 30 years through a unique Systematic Care ManagementSM model. This approach has consistently achieved results, backed by independent research, that exceed industry benchmarks for return-to-work and lifetime medical cost savings. A key differentiator is full risk transfer—instead of unit pricing or "à la carte" risk.

Value-based partnerships represent the next step in holistic risk management that returns injured workers to their jobs, homes, and communities, while lowering costs. To truly lead the way in a performance– and outcome–based payment model, Paradigm understood it would require an unprecedented level of collaboration that only leading provider partners could deliver.

As one of the top rehabilitation hospitals in the United States, Shirley Ryan AbilityLab was the natural choice for Paradigm to establish the first value-based partnership in workers' compensation. The Paradigm Outcome Plan was already built on an unsurpassed level of clinical expertise and data, but this new relationship will immediately provide access to Shirley Ryan AbilityLab's specialized clinical team and decades' worth of data immediately in the recovery process.

Shirley Ryan AbilityLab is an innovator and industry trailblazer in rehabilitation, recognized not just for the quality of both its functional and behavioral care, but for its depth of clinical research. As a "translational research hospital," Shirley Ryan AbilityLab surrounds patients with clinicians, scientists, and technologists who work together in the same space, discovering new approaches and translating research to care in real time.

Collaboration from the outset of care allows for the establishment of mutual benchmarks related to outcomes and cost that drive maximum functional and behavioral recovery. Building on an established relationship with a leading provider like Shirley Ryan AbilityLab allows Paradigm to set the high standard for value-based care that injured workers, their families, employers, and other industry stakeholders require.

Going forward, value-based relationships with best-in-class providers will represent the standard for Paradigm's Systematic Care Management model. Launching this initiative with Shirley Ryan AbilityLab brings extensive resources that can be leveraged from the beginning of the recovery process and integrated with Paradigm's proprietary outcome-based analytics.

A unique process raises the bar for provider relationships in workers' comp

Paradigm and Shirley Ryan AbilityLab have developed an innovative process to provide optimal results for patients and clients through a collaborative approach to clinical accountability. Aligning both short and long-term guaranteed outcomes with early post-acute care results will help more injured workers on a cost-effective basis. It is also an inflection point for the industry in establishing a working model for an accountable, performance-based payment system.

Standardizing this level of partnership will allow Paradigm and providers such as Shirley Ryan AbilityLab to fully realize and redefine value-based care in workers' compensation. Only a provider such as Shirley Ryan AbilityLab has the ability to engage at this level and only an organization such as Paradigm has the expertise, data, and resources to hold providers to a measurable outcome. Ultimately, working exclusively with best-in-class providers willing to engage in collaborative and holistic risk management will better facilitate optimal outcomes for patients and payers alike.

Learn more about this novel initiative that will help transform the lives of workers with catastrophic injuries so they can return to their homes, families, and ideally, to work. 

For more information, email [email protected].

Galia Kathleen HR v2.jpg.  A1717_AbilityLab_CGP_5982_PeggyKirk_color.jpg

Kathy Galia, Senior Vice President & General Manager, Clinical Solutions at Paradigm. Peggy Kirk, RN, Chief Operating Officer, Shirley Ryan AbilityLab

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