Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor!

Musculoskeletal (MSK) injuries have become a major category for suboptimal outcomes and rising costs in workers’ compensation. Too frequently, what should be a routine shoulder, knee, or back diagnosis develops into a large loss with delayed return to work. Of the $20 billion spent annually on work-related MSK claims,¹ these more volatile outlier cases represent a significant portion of medical, indemnity, and administrative costs.

In the current workers’ compensation system, injured workers, providers, and payers navigate a fragmented, misaligned fee-for-service framework that can derail recovery. Primary and ancillary providers are incentivized to focus on providing more treatment interventions and spending an outsized amount of time on medical documentation to optimize reimbursement. This misalignment takes the focus away from high-value patient care.

“Overstrained providers are drowning in administrative burdens and under great pressure to treat higher volumes of care faster, while injured patients struggle through a siloed industry that prioritizes activity over outcomes,” says Michael Choo, MD, Chief Medical Officer, Workers’ Compensation, Paradigm. “For MSK injuries, we need value-based solutions that fundamentally address this disjointed status quo.”

A Model for the Future of Work-Related Injury Care

Value-based models shift the incentive to outcomes for a single injury or event—instead of individual treatments. “Providers should be focused on overall health, quality care, and functional outcomes, and less on meeting volume demands and prior authorization requests,” explains Jennifer Doyle-Fidler, MSN, RN, Director, Clinical Product Solutions, Paradigm. “Higher-risk MSK cases benefit from early identification, dynamic patient engagement strategies, and proactive assessments that move care upstream.”

By identifying conditions and environmental factors that are common barriers to recovery, providers and care managers can work with injured patients to intervene sooner. For example, many psychosocial factors, from symptom magnification to perceived injustice, can be addressed subclinically with the right approach and resources. This strategy can shift attitudes and reduce the risk of a compensable behavioral health diagnosis.

Paradigm’s HERO MSK^SM is the first true value-based solution for work-related musculoskeletal injuries. This holistic solution identifies key risk factors and delivers appropriate interventions for guaranteed functional outcomes. Injured workers receive access to a high-quality provider network developed through cost and outcomes scoring, matched with best-in-class credentialing. Combined with a dedication to patient engagement and psychosocial support earlier in the care journey, HERO MSK ensures injured workers receive the attention and resources necessary for a successful recovery.

Key to the HERO MSK program are patient engagement tools carefully designed to support each recovery journey through real-time communication and data insights. Options are flexible and multimodal—including text, email, and a mobile app—to meet patients where they are and promote honest responses in a low-pressure environment. With accurate, real-time information, nurse care managers can develop and deliver risk assessments to claims teams for better insights on interdisciplinary care collaboration.