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Paradigm Health Plans®
MAPs the Way to Better Health
Paradigm Health Plans® was established in
2007 with a new idea and an ambitious goal:
to create and implement a health benefit
plan infrastructure that would transform the
workplace by improving employee health while
holding costs down. Today, Paradigm Health Plans is
growing rapidly and has two corporate offices in Hampton,
New Hampshire and Melville, New York. In the third quarter
of 2016, Paradigm will have six national offices strategically
placed to respond to the national interest in our plan models.
Healthcare costs—which have been growing for decades—
have now ballooned to an unsustainable level. Treatment of
chronic conditions such as heart disease, cancer and diabetes
now accounts for up to 75% of the nation’s overall spending
(National Coalition on Health, Oct. 2009). Yet three-quarters of
medical expenses for these conditions are preventable through
lifestyle changes and/or medication.
Fully-insured health insurers react to expensive claims by
increasing plan premiums. To mitigate higher premiums,
employers shift plan costs to workers in order to maintain their
current benefit levels, which doesn’t help the member save; or
offer workers a benefit level of lesser value, which could lead to
substandard care that worsens the member’s health—and to
higher medical costs.
Despite efforts to close gaps in healthcare coverage, many
Americans with private plans aren’t fully covered even though
a considerable amount of their income goes to their health
plans, according to a recently released Commonwealth
Fund report. Researchers found that 21 percent of adults
with private health insurance spent five percent or more of
their income on out-of-pocket healthcare costs even before
factoring in premiums. In that group, low-income adults had
the highest costs, which in some cases surpassed 10 percent of
their income.
Paradigm Health Plans believes that in order
for health plans to work for employers and their
employees’ families, Plan coverage must provide
adequate financial protection without sacrificing
access to high quality care.
Our expansion is rapid and underscores the value of the Paradigm
Health Plan model. In New York State alone, plan membership
exceeded projected revenues by 600% in 2015. Now Paradigm
Health Plans has employees throughout the U.S. to deliver our
message and begin the workplace health transformation!
For more information,
sales@paradigmhealthplans.org
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www.paradigmhealthplans.org | 888.303.0034
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Lifestyle-for-Life®
:
Health Management that’s
More than a Wellness Program.
Employers misunderstand if they think
that just any wellness program, by
itself, is the surest route to reducing
their overall health care spending. That
just isn’t the case. As a result, typical
employer wellness programs have been
weakened by studies that examine
their long-term impact. In part, these
programs have been ineffective at
focusing on long-term lifestyle changes.
Employers simply lack the resources
to implement ongoing comprehensive
health culture change even when
they have a vested financial and
organizational interest in keeping their
workforce healthy.
Paradigm Health Plans Lifestyle-for-
Life® Program is designed to address
those challenges. Beginning with a
biometric blood draw of up to 38 panels
at the workplace, Paradigm is able to
identify and stratify the unique clinical
risks for an entire workplace population.
Our Lifestyle-for-Life health management
program will identify high and moderate
at-risk participants and make sure they
can easily access the care they need
through their Paradigm Health Plan
benefits using the Member Advantage
Program. Our dedicated clinical team
builds an employer-specific approach to
addressing the unique clinical challenges
of their workplace, and shares
responsibility with the employer to
ensure success. Our continued successful
implementation of the Lifestyle-for-Life
program has provided our clients with:
• Measurable long-term improvement
in their health culture
• Identification of moderate and high-
risk conditions that lead to higher
claims costs
• 6-9% actuarial savings
• 7.7% reduction in medical spend in
second year
• 6.4% lower medical spend in
third year
• Sustained premium costs, with
average increase of just 3%—a
nearly 9% savings compared to the
regional average premium increase
of 12%
Paradigm Health Plans understands that
benefits and lifestyle programs work
best when they’re geared directly to
individuals, so that both employers and
employees can reap superior benefits
relative to their options. We created the
Member Advantage ProgramSM
(MAP)
to be that solution. This revolutionary
program is unlike any other benefit plan
in the nation, and is the cornerstone of
our success.
It’s a sad fact: Americans no longer
trust their health insurance. Growing
out-of-pocket costs, confusing benefit
plans, and fewer network choices leave
plan members frustrated. They feel that
there’s no one they can trust to explain
how the plan could work for them,
personally which has resulted in loss of
high-quality care delivery.
Our Member Advantage Program
(MAP) embedded in Paradigm Health
Plans benefits makes accessing high-
quality care easier and benefits1
more
understandable for the member.
This ensures that members do not
miss important healthcare services—
including critical preventive care—either
to avoid the expense or because they’re
unaware of the benefit. Research shows
that people with insurance who have
high healthcare costs relative to their
income are as likely to skip needed
care as those with no insurance at all.2
This impacts both employer and the
employee. Delays in preventative and
critical care lead to higher-than-average
claims costs for employers.
The MAP team consists of highly-trained
benefit experts dedicated to each and
every Paradigm member. Through this
program, MAP professionals “MAP the
GAP” in member understanding of the
plan so that members can fully maximize
their benefits. MAPs contact members
before coverage begins to provide a full
benefits overview; answer and resolve
EOB questions; help reduce or eliminate
deductible and co-payments; help find
high-quality in-network providers and
pharmacies, and assist in quality and
cost comparisons; schedule provider
appointments; and keep members
up-to-date on preventive services.
The Solution
Paradigm Health Plans’ core mission is to deliver value-based
health plan designs that empower employers and employees
to actively manage their healthcare costs.
We were able to develop flexible Plan options for
Administrative Services Only, self-funded and level-funded
health plan groups, as well as assurance on healthcare costs
over a one- to three-year period.
Today, Paradigm Health Plans offers a
variety of plan types, including:
• EPO/PPO Health Plans (Acclaim and
Inspire Plans)
• 51 FTE and above enrolled and
maintained
• Wage Parity/Living Wage Plans
• Supplemental Coverage for Living Wage
• Minimum Value (MV)
• Minimum Essential Coverage (MEC)
• Ancillary Coverage including Dental,
Vision, Long-Term Disability (LTD), Short-
Term Disability (STD) and Life Insurance
Network Choices:
Access without Disruption.
Paradigm Health Plans continues to partner with businesses and
empower employees to actively manage their healthcare costs through our
Member Advantage Program. Today, Paradigm Health Plans members have access
to major Tier 1 PPO National Networks with thousands of high-quality physicians,
specialists, hospitals and ancillary facilities in all 50 states. On average, Paradigm
Health Plans clients experience less than 2% in disruption when they partner with us!
1 Paradigm’s Member Advantage Program is excluded from Minimum Essential Coverage Programs.
2 Commonwealth Fund Report 2011, Sam PK Collins,”Why Insured Americans are skipping out on healthcare”, - redaction NY Times, November, 2014