By: Maria Williams
Sudden changes in systems that have been operating the same way for decades are often feared and delayed. That also applies to the crucial workers’ compensation (WC) sector, and, as noted by Jamie LaPaglia, this industry’s growth has been put on hold for much too long. As a fierce advocate for developing effective evidence-based treatment solutions, LaPaglia created Claim Clarity, an end-to-end high-tech solution for the workers’ compensation industry.
LaPaglia’s extensive experience includes working at a trauma center, being a member of several critical response teams, and assisting in transporting ill patients across the world. His 24-year-long involvement with the healthcare space equipped him with across-the-board expertise and instilled a sense of responsibility, inspiring LaPaglia to improve the industry he cherishes so much.
As a Registered Nurse with over 24 years of experience, LaPaglia witnessed many heart-wrenching situations of patients struggling with insurance claims or of unaware doctors prescribing incorrect medicine. “I was doing very well in my field and felt I had a bright future. However, I needed to abandon bedside nursing. When I think about my reasons for leaving, I think of every single patient struggling with compensation or suffering because of the problems in the system. I knew that, unless I did something drastic, healthcare would continue to underdeliver,” added LaPaglia.
As the healthcare sector continues to have a grave impact on people’s lives, it’s necessary to develop innovative solutions that address the numerous issues of the industry. As stated by LaPaglia, “Most of the workers’ compensation treatments get denied because people handling the system are looking at the wrong information. In the US alone, there are over 10,000 different guidelines, and all requirements vary from state to state.” The overabundance of data makes it nearly impossible for an average human to filter through, increasing the risk of denied reimbursement.
Most US states don’t have the resources to curate a specific state-based guideline, and many people rely on commercially available manuals developed by organizations, such as ODG by MCG. These guidelines allowed many injured employees to access accurate information. However, as beneficial as they are, the lack of filtering systems makes it difficult to reach the desired data quickly.
On top of his impressive healthcare experience, LaPaglia also worked in various leadership roles across managed care, where he was leading teams in utilization management, case management, peer/IME reviews, and data. The expertise LaPaglia gained in leadership roles, combined with his deeply rooted passion for helping people who cannot help themselves, allowed him to develop Claim Clarity, a trailblazing tool that improves and scales tens of thousands of available guidelines.
It achieves this by standardizing and unifying the vast amount of relevant claims data, including the multitude of state-specific guidelines, and presenting that to the stakeholders responsible for making compliant medical care decisions. Furthermore, Claim Clarity can, in some cases, fully automate the decision-making process, accelerating the delivery of safe and effective healthcare for injured workers.
LaPaglia’s reasons for unwaveringly revolutionizing healthcare go deeper than sheer passion and are extremely personal. When his father was taken into ICU due to serious health complications, LaPaglia’s family wasn’t hopeful about his father’s fate. “No doctor was able to find the cause for his mysterious and harrowing condition. Everyone prepared us for the worst, and I couldn’t help but feel helpless. All it took for the situation to get better was finding the right guideline, which stated that some of my dad’s medications shouldn’t be mixed. After putting it away, he fully recovered within a week,” shared LaPaglia. This traumatic experience made him realize the importance of accurate data and how crucial it is to access the right information efficiently.
Jamie LaPaglia, Registered Nurse, founder of Claim Clarity, and a passionate advocate for accessible healthcare, believes in constant growth and improvement and hopes his high-tech solution will enable injured employees to make more informed decisions about healthcare. He says: “I’ve always been an advocate of doing the right thing, and that steered me in the healthcare direction. I feel like, for whatever reason, many people don’t know how to help themselves, and it’s my mission to stand up for them. With the medical industry being so serious, I knew this was the right opportunity for me. I had enough knowledge to develop a unique end-to-end system that empowers people, leads them to make better decisions, and brings better results.”
