WALNUT CREEK, Calif., July 16, 2020 /PRNewswire/ — Paradigm, the industry leader in solving catastrophic and complex health care challenges and improving lives, today announced the findings from an independent study commissioned with Boston Strategic Partners, Inc. (BSP), which determined Paradigm Specialty Networks’ cost reduction performance on implants far exceeds the industry standard. Boston Strategic Partners affirmed that “Fusion by Paradigm℠,” a data-driven implant cost containment solution, reduces implant costs by 25 percentage points more than the typical industry outcomes.
Paradigm added Fusion to its suite of services in 2017 through its acquisition of ForeSight Medical, a surgical management pioneer in the workers’ compensation industry. Fusion is a proven solution with a 10-year track record of success that powers the most robust implant management adjudication process in the industry.
“Implant cost containment continues to be a major pain point for insurers, as workers’ compensation surgical implant procedures are often billed and reimbursed inconsistently, with questions of transparency throughout the process,” said Fabian D’Souza, MD, President and Founder of Boston Strategic Partners. “Our study aimed to compare the effectiveness of Paradigm’s forensic analysis to the industry standard negotiation-based approach. It’s clear, based on our quantitative analysis, that Fusion by Paradigm is a superior approach that generates significant cost reductions for workers’ compensation payers when compared to typical industry results.”
Founded in 2003, Boston Strategic Partners, Inc. is a global health care analytics firm focused on health economics and outcomes research. The BSP study sourced 137 million lines of claim data from industry sources, including the Fusion by Paradigm reference price database, concluding that Paradigm Specialty Networks achieves the highest cost savings across the industry.
According to BSP, the lack of manufacturer implant pricing transparency often leads to insurer overpayment, potentially up to two times the cost to the hospital. In BSP’s independent analysis of industry practices and outcomes, Fusion by Paradigm outperformed the industry in delivering cost savings across key procedural categories, including the following:
- Orthopedic procedures represent a significant number of surgeries paid for by workers’ compensation payers. The study revealed Fusion by Paradigm reduces fixation procedure costs by an average of 25 percentage points over the industry standard.
- Spinal procedures, including cervical fusions and neurostimulator implantations, are often associated with high implant costs. Fusion by Paradigm generates cost reductions that are on average 18 percentage points higher than typical industry savings across these procedures.
- Neurological and cranial procedures achieve significant cost savings with Fusion by Paradigm, with implant cost reductions surpassing the industry average by an additional 16 and 14 percentage points, respectively.
Fusion uses a four-phase adjudication process that generates consistent, data-driven allowances for workers’ compensation payers. In addition to forensic assessment and the determination of objective allowances, Fusion is differentiated by its proprietary reference price database, which incorporates real-time data to ensure the most up-to-date implant costs are factored into the review process. Paradigm Specialty Networks provides a thorough explanation of review to the provider with each adjudicated case and stands by its allowances with full defense.
“Fusion represents a modern-day approach to implant cost containment,” said Ken Hannigan, Chief Executive Officer, Paradigm Specialty Networks. “Our approach differs from the industry’s typical negotiation-based approach. Instead, we have designed a proven adjudication process that works to determine the true, researched-based cost of implants. The result, as verified by BSP, yields significant cost savings for workers’ compensation payers. BSP’s independent findings are a strong validation of our superior approach, which has been engineered and honed for 10 years to produce the most dependable and significant cost reductions in the industry.”
To learn more and to download the white paper featuring the study findings, visit: https://info.paradigmcorp.com/implant-cost-containment-download-form
For almost 30 years, Paradigm has been the industry leader in solving catastrophic and complex health care challenges and improving lives. With the most connected and experienced team in health care, we define and deliver outcomes that exceed financial and health expectations for our clients, as well as for individuals and their families.
Paradigm delivers its solutions through three divisions: Catastrophic Care Management, Complex Care Solutions, and Specialty Networks. The Paradigm divisions are built on expertise from six best-in-class businesses: Paradigm Outcomes, The ALARIS Group, Encore Unlimited, Restore Rehabilitation, ForeSight Medical, and Adva-Net. Founded in 1991, Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit https://www.paradigmcorp.com/.
Paradigm Specialty Networks offers innovative, data-driven network solutions for the most challenging, expensive, and unmanaged segments in workers’ compensation: orthopedic and spine, pain management, addiction, post-acute care, behavioral health, and surgical implants.