Two Workers' Compensation Health Care Organizations Certified in California

Employers, workers given more options for health care by California Department of Industrial Relations

Injured workers in California and their employers now have more physicians, specialists and hospitals from which to choose.

The California Department of Industrial Relations'' Division of Workers'' Compensation (DWC) certified two new health care organizations (HCOs) to provide medical care for workers injured on the job. The addition of the two HCOs will add thousands of physicians, specialists and hospitals to those already certified in the state.

The latest programs to be certified, Comp America Primary and Comp America Select, are offered by Employer and Occupational Services Group (EOS), a subsidiary of Health Net Inc., one of the largest health care companies in California.

EOS has a large statewide network of over 14,000 primary treating physicians, with thousands of specialists and hospitals.

"These certifications will substantially increase the options businesses have for using HCOs to deliver medical treatment of workplace injuries," says DWC Administrative Director Richard Gannon.

Once an HCO is certified, employers and insurers may contract with the organization to offer their employees a medical plan for occupational injuries. Employees can opt to enroll in the plan or pre-designate their own personal physician. Depending on the overall health coverage they offer, employers gain additional time during which they control medical treatment for an enrolled employee.

"I am particularly pleased to sign these new certifications," notes Gannon. "HCOs help employers and their workers improve medical care quality and early return to work programs while controlling workers'' compensation costs."

Certified HCOs must provide a quality assurance and improvement process, medical case management, coordination of return to work services with the employer and a grievance system. They must also report preventable health problems to the employer to improve workplace health and safety. They report data on medical treatment patterns, costs and outcomes for patients receiving HCO care to the DWC annually.

"HCOs are an increasingly popular way for employers and carriers to provide medical care for injured employees," adds Gannon, who adds there''s been a recent growth spurt in HCO enrollment.

Three new programs were certified at the end of last year and enrollment overall has grown substantially, to over 150,000 employees during the first half of 2001. These new certifications bring the state program''s total of HCOs to 14. A list of certified HCOs can be found on the DWC Web site at www.dir.ca.gov/dir/Workers''_Compensation/DWC/HCO.htm.

by Sandy Smith

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