Paradigm CEO John S. Watts, Jr., explores taking a value-based care approach to achieve patient-centered care. Read an excerpt from his article, Patient-Centered Care: A Focus on Optimal Recovery, in Brain Injury Professional.
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Before becoming Paradigm's CEO in 2017, I spent my career in healthcare, leading large payer organizations and advising several private equity backed healthcare companies. I held numerous management positions at Anthem, then the nation's largest insurer, including President and CEO of Blue Cross Blue Shield of Georgia, President and CEO of Anthem National Accounts, and President and CEO of Anthem's Commercial and Consumer Business.
My years as an insurance executive in group health, where health plans help to access care and manage disease-related needs and interventions for individuals, gives me perspective on the immense value of focusing on meaningful clinical outcomes with financial accountability, as Paradigm does. Value-based care makes a tremendous difference in people's lives, especially those with a complex injury like TBI. The highest priority must be to do the right things for patients at the right time to achieve the meaningful outcomes.
Catastrophic injuries require a comprehensive approach that supports everyone involved, every step of the way. Paradigm's model places the patient at the center of a dedicated case management team that is solely focused on an optimal medical recovery. Traumatic brain injury and other medically complex cases are difficult challenges for all stakeholders. To achieve greater results, these patients require care from those proficient in specialized skillsets and capabilities.
A patient who recovers to the fullest extent possible from brain injury avoids a long tail of medical volatility and complications. Fewer complications translates into lower long-term medical care costs. As the total cost of a catastrophic claim usually reaches into millions of dollars, savings on a relative handful of claims are significant.
This long-term financial exposure is far greater than the indemnity cost exposure, or even the highly expensive initial medical care costs during both the acute and rehabilitation period (the first 18-24 months).
In fact, Milliman, Inc., the nation's leading actuarial consulting firm, studied more than 60,000 catastrophic cases, and found the industry distribution of spend during the lifetime of a catastrophic claim to be made up of 83% medical expenses vs. 17% indemnity expenses.
The impact of long-term claim expense is dramatic. To reduce long-term costs, the best path is to bring the claimant to the highest clinical outcome during the acute and rehabilitation period.
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