Santa Ana, CA – Paladin, a provider of managed care services, recently announced at the 2012 Risk Management Society (RIMS) Annual Conference & Exhibition in Philadelphia, the addition of a new physician-guided service, Physician Case Management.
Paladin’s physician-guided services achieve dramatic, positive results for policyholders, carriers, and patients. Paladin’s overall improvements in results include 11 percent faster return to work and an 8 percent reduction in claims cost. The addition of their Physician Case Management service has proven to further extend this performance lead.
“With our Physician Case Management service, our in-house doctors work with our clients’ claims examiners to manage the medical aspects of any case that could involve six weeks or more of lost work time,” said Jeffrey D. Miller, chief operating officer at Paladin. “By overseeing the patient’s medical treatment and approving drug requests from the beginning of a claim through the provision of the service, we produce a better outcome for the patient, without incurring undue costs for our clients.”
Currently, the industry uses the legacy indemnity model to manage medical care, with nurses and claims examiners overseeing the medical component of a claim. If there is a question or issue about the care, the nurse must consult with a physician to get an answer, a step that slows down the progress of the case. Furthermore, when the physician is not meaningfully involved in the beginning of the case, the treatment plan can become fragmented and care may be delayed, leading to a slower recovery, higher costs, and even medical complications.
With Paladin’s unique approach, which combines physician-guided care with technology-driven efficiency, an in-house physician is involved in the claims process from the onset—in every service. This eliminates wasted time, provides the treating physician with the right input from the start of the claim, and moves the case forward, faster. And the results are impressive, ranging from a 3400 percent return on a client’s investment (ROI) in Paladin’s Medical Bill Review service to an 1800 percent ROI in their Utilization Review service.
“Medical care and its cost is a huge problem, especially in workers’ compensation. While it may be intuitive that physicians should guide medical care, this approach has not been implemented, until now,” said Marc Miller, M.D., senior vice president and chief medical officer at SeaBright Holdings. “When this physician-guided model was developed, it was a real breakthrough and a better solution than traditional approaches. The data proves it is indeed transforming managed care, benefiting the patient, the insured, and the insurer.”
In addition to the new Physician Case Management service, Paladin offers a range of managed care services, including Medical Bill Review; Rx Utilization Review; Physician On Call; Utilization Review; 24/7 Nurse Triage; Claims Analysis, and Medicare Set-asides.
Paladin Managed Care Services will be in Booth #1160 at the 2012 RIMS Annual Conference & Exhibition April 15-18. Medical Director Dr. Paul Wakim will be giving in-booth presentations at the top of every hour on how Paladin is transforming managed care and achieving extraordinary results.