WILLIAMSVILLE, N.Y., April 23, 2024 — Penstock Group announced today a partnership with Paradigm, an accountable specialty care management organization and developer of a proprietary payment integrity program assuring accurate payments for surgical implant claims.
Penstock, a leader in the healthcare payment integrity space focused on delivering innovative and niche results, saw a unique opportunity to integrate Paradigm’s robust and established expertise into their programs to enhance claim accuracy in the area of surgical implants.
“Paradigm has been a pioneer in value-based care for more than 30 years,” says Penstock president Laura Collier. “Penstock has fairly quickly established a reputation and track record for finding niches in the payment integrity space that others overlook. Paradigm’s expertise in this area and Penstock’s culture of innovation line up perfectly to provide full transparency and payment accuracy.”
The partnership will include a seamless integration with ClearBridge, Penstock’s comprehensive SaaS payment integrity solution that facilitates a more effective and efficient claims auditing process. ClearBridge is an audit management technology that optimizes workflow and offers seamless self-service for auditors that negates the need for constant IT assistance, including intuitive search, advanced reporting and agile edit development.
“The inner workings of the medical device supply chain and evolution of the technology of the devices themselves are intricate and complex,” says Collier. “Payers are routinely overpaying in an area that amounts to more than one-fifth of all surgical spend.”
Paradigm’s comprehensive Implant Savings Program identifies savings opportunities through expert bill review and industry-specific data, ensuring accuracy in surgical implant claims. The program delivers an average savings of 69% for payers.
Paradigm specializes in reviewing charges for surgical implants — with over 200,000 cases reviewed to date. Paradigm’s surgical implant review experts, in tandem with a proprietary database, generate savings that far exceed those found using typical surgical claim review approaches — a key piece to reducing the unnecessary spend that is so pervasive in healthcare. Ninety-eight percent of surgical implant cost savings identified by Paradigm are upheld after any appeal and 88% of total bills remain undisputed.
“This partnership brings together two industry leaders who are committed to going above and beyond to fix core cost challenges in the industry and create proven and sustainable solutions,” says Paradigm Chief Networks and Operations Officer Chris Pricco. “By integrating with ClearBridge, a wider range of payers will have access to Paradigm resources as part of a comprehensive audit and payment integrity platform.”
About Penstock
Penstock is a service partner and SaaS builder for forward-thinking health plans, empowering recovery, audit and regulatory teams to get accuracy right from the start—when it matters most. With payment integrity and regulatory technology and services, Penstock removes inefficiencies, costly errors and wasteful spending, ultimately lowering healthcare costs for payer organizations and their members. Penstock is part of Goodroot, which launches and scales companies dedicated to increasing access and affordability in healthcare. penstockgroup.com
About Paradigm
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.
