ParadigmCares Corner

Paradigm is committed to helping students of parents who’ve su�ered a

catastrophic work injury. As the largest sponsor of Kids’ Chance of America, our

scholarships help these children achieve their education goals. Paradigm is also a proud sponsor

of The Alliance of Women in Workers’ Compensation. This think-tank of engaged thought

leaders is committed to facing the challenges and emerging trends in workers’ compensation head on.

www.paradigmcorp.com

Clinical Connection

The Benefits of a Bending Brain

Across the industry, we are seeing increased medical interest surrounding the innate ability of the brain to change its structure and adapt to injury or illness. This “neuroplasticity” is lending to a host of new pain management interventions that rank high-to-low on the conservative spectrum: mind/body techniques, medications and technologies.

By design, the brain has to be neuroplastic as it adapts each millisecond to electrical and chemical reactions that result in perception and action. Given this malleability, certain pain management interventions are able to prompt the nervous system to revert back to normal functioning after a traumatic event.

Beyond mindfulness, meditation and yoga, medications can move past targeting the peripheral muscles and also in�uence how the brain updates the way it functions. More invasive techniques, such as spinal cord stimulation for chronic pain and deep brain stimulation for certain severe movement disorders (i.e. Parkinson’s disease), are also cited as having an impact on the brain’s re-structuring. Outcomes can be very positive in carefully selected individuals, but much more limited in the larger population. There has been a big push in developing various forms of electrical stimulation technologies and devices. Even transcranial magnets are being explored. The basic contention here is that since the nervous system operates on electrical current, we should be able to apply external currents to force it to modulate.

The remaining major question is: What are the e�ectiveness limits to these techniques? Neuroplasticity is how the brain functions, but it is not boundless. As neuromodulation is further explored, we should be cautious, evidence-based and always optimize the most conservative options possible.

Source: Steven Moskowitz, M.D., Senior Medical Director, Paradigm

The best specialists.The best outcomes.

Specialty network and cost management solutions for high-acuity injuries.

Orthopedic and Spine Network Comprehensive Pain Management Network Addiction Recovery Network Post-Acute Care Network Behavioral Health Network Surgical Implant Cost Management

Specialty SpotlightFall 2019

Watchlist Focus

Implant Billing: Did You Know?

Third-party implant billers, while they come and go in the market, are a driver of surgical spend that can be contained. What this means for payers is needing to recognize duplicate billing for implants on the date of surgery, as the rendering facility can inadvertently include the implant charges on its bill. External implant billers typically charge well above the facility’s acquisition cost on the bills they generate. Specialty Networks can automatically �ag these third-party Tax IDs for comprehensive implant bill review, removing this burden of additional audit from the payer.

Market Movements

Breaking Through with Behavioral Health

Eye Movement Desensitization and Reprocessing (EMDR) is a highly e�ective psychotherapy treatment in alleviating distress associated with traumatic memories. When a person is exposed to an accident, the “�ght or �ight” reaction occurs, releasing adrenaline and cortisol. These stress hormones divert oxygen from the brain to the large muscles, preparing the body to run from danger.

As a result, neurons in the brain are damaged and stop functioning, creating the essence of scars. EMDR capitalizes on the brain’s neuroplasticity to build new pathways around the damaged neurons, giving the memories leading up to the trauma a “detour.” This enables the person to psychologically move beyond the paralyzing moment and reduce further traumatic impact on the brain — as opposed to older methods like Jungian talk therapy that continually rehash the incident. While the memory of the event remains, the related emotions are no longer as disabling to the person’s life.

Source: Delainne Bond, Senior Director, Implementations & Clinical Services, Paradigm Specialty Networks

Care Coordination

The Fast Five: Post-Acute Patient Planning

As an adjuster or case manager �elding multiple phone calls from a variety of post-acute care providers, you know that identifying the highest quality resource is challenging. Here are �ve key questions worth considering to ensure you seek the best treatment options for your injured associate:

Does the provider have an easily understandable interim plan of care as part of the pre-admission process? And once admitted: a master plan of care? Does the provider help each patient become an active participant in their treatment, with speci�c goals to help them de�ne their post-injury abilities and self-identity? Does the provider treat a critical mass of similar catastrophic injuries?Does the provider have a long-term commitment to their patients and family members through aftercare? Does the provider have published outcomes data, participate in best practice programming, or have peer-reviewed treatment research?

Source: Stan Smith, Senior Vice President, Paradigm Specialty Networks

Specialty Spotlight | Fall 2019 - Page 2

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Visit Us in Las Vegas!Booth 2022

What Treating the Whole Person Really Means

Please join our talented team for a discussion on how addressing an injured worker’s environmental, spiritual, and emotional needs helps mitigate the inevitable challenges that can delay recovery. Psychosocial services focus on the ongoing interpersonal needs of an injured worker and their family, however in addressing these needs, one size does not �t all.

When: Wednesday, November 6(11:00AM and 2:00PM PST)

Where: Paradigm Booth 2022, Mandalay Bay Convention Center

Ask a Provider

Orthopedic and Spine Insights

Leveraging his 21 years of experience treating spinal disorders for those injured on the job from his busy South Florida practice, Paradigm Specialty Networks provider Dr. Christopher Brown knows the critical importance of the orthopedic provider in workers’ compensation. We had the opportunity to talk with him about the rapidly changing treatment landscape:

Q How do you see the outpatient surgery environment changing in the short and long term?

A Speci�cally for spine surgery, I see that there will be more spine surgery performed in the outpatient surgery environment, particularly in places where the patient may be able to stay somewhat longer than the usual

outpatient setting.

Q What would you consider to be the top spine surgeries currently handled in the ASC setting, and do you feel that the 24-hour format will provide more opportunity for patients and your practice?

A Lumbar discectomies are probably the most common. I feel that the 24-hour format will allow more cervical surgeries to be performed in an ASC setting as they really need to be observed — should post-op hematoma occur.

Q How do you run a responsible, conservative surgical practice?

A Every patient is an individual and has unique history and needs. That is really taken into consideration when evaluating and treating a patient. The basic truth is that as long as there is no neurologic injury, most patients can be treated conservatively and will improve with that conservative treatment.

Q What are your keys to success when administrating the treatment plan for a workers’ compensation claim?

A A lot depends upon the individual patient. One complaint that I hear commonly from patients who may come from elsewhere is “they don’t care about me.” It is important to let the patient know that we will work as a team to help get the patient better and back to all their activity, including their regular job.

Q What would you say speci�cally sets you apart from your colleagues in the orthopedic space?

A I have (personally) had cervical and lumbar disc herniations with radiculopathy, and have gone through conservative treatment with signi�cant improvement. I think that experiencing the diagnosis and symptoms associated with the diagnosis really helps give me a better understanding of what patients are going through.

Q How do you ensure you stay current with your condition-speci�c expertise?

A I maintain board certi�cation and attend numerous courses and spine society meetings.

Source: Christopher A. Brown, M.D., F.A.A.O.S, Orthopedic Associates USA

Company News

Provider Welcome!

Paradigm Specialty Networks is proud to announce the addition of the following leading providers to its fold:

Encompass Health (Post-Acute, National) Hinsdale Orthopaedic Associates (IL) Interventional Spine & Sports Medicine (Pain, CT) Kemah Palms Recovery (Addiction, TX) Lancaster Orthopedic Group (PA)

Statistics Central

Weighing ASC’s and Hospitals (By the Numbers):

Surgical Infection Rates

Hospitals: 1% for procedures such as knee and houlder surgeries.ASC’s - 0.1% (one tenth of the hospital rate)

ASC Market Scale

53% Medicare’s payment share of the procedures performed in ASC. 7 Million Procedures performed in an ASC under Medicare per year

Savings Impact

$2.3 Billion in savings when certain preventive and surgical procedures are performed in ASC vs. Outpatient Hospital. Ex: Joint replacement - ASC ($18,000) vs. HOPD ($40,000)

Source: Becker’s ASC Review, American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)

Paradigm Cares Corner

Paradigm is committed to helping students who have had a parent su�er a catastrophic work injury. As the largest sponsor of Kid's Chance of America, our scholarships help these children achieve their education goals. Paradigm is also a proud sponsor of The Alliance of Women in Workers’ Compensation. This think-tank of engaged thought leaders is committed to facing the challenges and emerging trends in workers’ compensation head on.

ParadigmCares Corner

Paradigm is committed to helping students of parents who’ve su�ered a

catastrophic work injury. As the largest sponsor of Kids’ Chance of America, our

scholarships help these children achieve their education goals. Paradigm is also a proud sponsor

of The Alliance of Women in Workers’ Compensation. This think-tank of engaged thought

leaders is committed to facing the challenges and emerging trends in workers’ compensation head on.

Industry Development

Alert During Surgery: The Next Frontier

Imagine being a surgeon performing a lumbar fusion and communicating with your patient during the procedure. It sounds unimaginable, but it’s possible. A surgeon can now receive feedback directly from the patient through the “Awake Spinal Fusion” technique. This minimally invasive, transforaminal lumbar interbody fusion requires only light or local anesthesia and is showing positive results. Patients are now at lower risk for surgical complications and resulting revisions, and are being discharged from the hospital sooner — driving down overall costs. Similar or improved outcomes are surfacing when compared to open spinal fusion surgery.

Source: Becker’s Spine Review and Johnson & Johnson

IT Matters

Protecting What’s Important

Specialty Networks is committed to keeping up-to-date on information security threats and trends. As an example, knowing 75% of healthcare organizations are a�ected by malware, we continuously assess our IT infrastructure to put controls in place that prevent such attacks. We are currently undergoing a rigorous SOC 2 Type 2 Assessment and a HITRUST Initiative to provide assurances that our information security practices are operating e�ectively and thoroughly.

Human-Centered, Outcomes-Driven

And Always Ready to Connect

Our new website represents Paradigm’s commitment to transform the lives of injured workers and their families across all of our divisions. As we’ve evolved through acquisitions, our diverse companies continue to closely share a uni�ed vision (our “North Star” metric) of putting people �rst.

A new online referral form now makes it even simpler and easier to send us a case. Take the �rst step to a better outcome.

referrals.paradigmcorp.com/psn

For more information, please contact:(844) 443-2792 o�cenetworks@paradigmcorp.comwww.paradigmcorp.comSpecialty Spotlight | Fall 2019 - Page 4

Sources: Advisory Board, Ambulatory Surgery Center Association, Vizient

Statistics Central

Weighing ASCs and Hospitals (By the Numbers):

ASC Market Scale

53% of what Medicare pays in outpatient hospitals is spent on the same procedures performed in the ASC

7 million procedures administered in ASCs under Medicare per year

Surgical Infection Rates

Hospitals: 1% for procedures such as knee and shoulder surgeries

ASCs: 0.1% (one tenth of the hospital rate)

Savings Impact

$2.3 billion in savings when certain preventive and surgical procedures are performed in an ASC vs. outpatient hospital. Ex: Joint replacement, $18,000 vs. $40,000.