About

Centers of Occupational Health and Education (COHEs) are community-based resources through partnerships with four leading health care organizations. The COHEs currently provide support to over 1,000 health-care providers.

COHEs

• Renton COHE at (vmccohe.valleymed.org) at Valley Medical Center, Renton, WA.
• Eastern Washington COHE (www.goCOHE.com) at St. Luke's Rehabilitation Institute, Spokane, WA.
• The Everett Clinic (www.everettclinic.com).
• Harborview Medical Center
• Map showing location of COHEs
• Graphic showing COHE model

The COHEs improve injured worker outcomes and reduce disability through a community-based change in health care delivery.

Delivery of care based upon occupational medicine model:

• Improved care coordination.
• Emphasized early return to work.
• Provided integrated case management.
• Fostered provider-employer communication.

Quality indicators developed to promote occupational health best practices:

• Submission of accident report.
• Use of activity prescription forms.
• Provider-employer communication.
• Assessment of barriers to return to work.

Financial incentives for meeting Quality Indicators targets:

• 50% increase in payment for submission of accident report within 2 business days

Key points from research on the effectiveness of the COHEs

• Background - L&I worked with Washington business and labor representatives to design and implement the Centers of Occupational Health and Education (COHEs).

Workers Compensation Advisory Committee, Health Care Subcommittee - This is an advisory committee of representatives of business, labor and the Board of Industrial Insurance Appeals, which has provided advice and direction to the project from its beginning.

Providers

What does involvement in the Centers of Occupational Health and Education (COHE) mean to you, the provider?

• Training in occupational health best practices.
• Access to the COHE medical director.
• Access to COHE mentors which include specialists who agree to see injured workers promptly and advise on clinic issues.
• Claim assistance from the COHE Health Services Coordinators.

What do providers in the Centers of Occupational Health and Education do?

The providers in the project are trained to follow occupational health best practices with all their injured worker cases.

Who are the COHE Health Services Coordinators and what do they do?

The Centers of Occupational Health and Education utilize Health Services Coordinators (HSCs) during the first 12 weeks of a claim to help participating providers navigate the workers’ compensation system and keep track of the injured workers they are treating. HSCs provide care coordination and early return-to-work coordination. 

If you are a worker or the employer of a worker with a medical provider who participates in COHE or a COHE provider, you may hear from an HSC. You are also welcome to call a COHE HSC for help on your claim. See the About page for links.

Tools for Providers

• Billing for best practices.

  Billing for Best Practices - Effective July 1, 2009 - Must sign up as a COHE provider to receive enhanced payment for these codes. Remember to bill in a timely manner.

  1. 1040M - Report of Accident

  a. Payable for any ROA sent to L&I within 2 business days of the first medical visit.
  b. $54 (50% more than the usual fee)
  c. Link to ROA
  d. Link to path of ROA graphic

  2. 1069M - Completion of the Activity Prescription Form (APF)

  a. Payable to COHE providers when communicating changes in work status.
  b. $49.18
  c. APF training points for COHE providers

  3. Phone calls to employers – all calls to employers should have the 32 modifier
  Medical Aid Rules and Fee Schedules

  4. 1068M - Assessment of barriers to Return to Work

  a. $131.06 (non-facility, non-mentor)

2009 COHE Fee Schedule (166 KB PDF) - effective July 1, 2009 through June 30, 2010.

• Talking points - Suggestions for talking with an injured worker

  One key occupational health best practice is to get an injured worker back to work as soon as medically appropriate after an injury occurs.  The worker, medical provider and employer must start this conversation quickly and be sure that every voice is heard.  Whether you are the doctor, injured worker or employer when a claim is filed, you can ask the question: “What about return to work?”

  Here are some important points that occupational injury and disease specialists recommend that you consider.

  • “Activity helps you recover.” Explain that returning to some level of work and activity will help patients recover from common injuries faster than prolonged bed rest.  Be sure patients understand the level of activity they can do at home and work.  Emphasize what they can do.
  • “Some discomfort is normal when returning to activities after an injury.” Discomfort from activity is different from pain that indicates a serious problem or setback.
  • “You can help with your own recovery.” Make sure your patients understand that while you can help with pain and healing, they play an equally important role by following your instructions.
  • “You can protect yourself from re-injury.” When musculoskeletal injuries are involved, talk to patients about how changes in the way they move or do their jobs can prevent other injuries.
  • “Early and safe return to work makes sense.” The longer you are off work, the harder it is to get back to your original job and wages. Even a short time off work takes money out of your pocket because time-loss benefits do not pay your full wage

• L&I Claim and Account Center (CAC).

• L&I Claims and Account Center (CAC) - Secure access to the claim file:

  • Workers, providers, employers, vocational service providers, and others to whom an injured worker grants access may view.
  • Able to send secure email to the claim manager via this site.
  • Go to: http://www.lni.wa.gov/ORLI/LoGon.asp, see "Common Questions" for more information.

Links about return to work -

• Attending Doctor's Return-to-Work Desk Reference (615 KB PDF).
• Employer’s Return-to-Work Guide
• Early Return-To-Work
• Employer's Job Description (A fillable form - 95 KB PDF).

 

Worker

What does COHE mean to you, the worker?

The Centers of Occupational Health and Education (COHE) work with you, your medical provider, and your employer to help you return to work.  COHEs offer the following services:

• Medical providers trained in occupational health best practices.
• Timely referrals to medical specialists when appropriate.
• Health Services coordination.
• Return-to-work assistance.
• Telephone calls from a COHE medical provider to you or your employer.
• Telephone calls from COHE health services coordinators (HSCs) to you or to your employer.
• Claim notification to your employer.

Back to work, back to health. Research shows that returning to normal activity as soon as safely possible after injury reduces the likelihood of long-term disability.  Developing goals for returning to work may improve your overall health and outcomes while protecting your income and benefits. 

Verify if your doctor is part of a COHE. You may want to call your COHE medical provider, a COHE health services coordinator or your employer to start this conversation.

For more information on why returning to work quickly is an important part of your recovery, click on the links below.

• Getting Back to Work: It's Your Job and Your Future (F200-001-000)
• Talking points for return-to-work

Key results from the University of Washington evaluations of the COHEs.

Other worker resources available from L&I:

• Injured? What you need to know
• L&I Claims and Account Center (CAC):  http://www.lni.wa.gov/ORLI/LoGon.asp
  Secure access to the claim file for workers, providers, employers, vocational service providers, and others to whom an injured worker grants access. 
  • You are able to send secure email to the claim manager via this site.
  • See “Common Questions” at this link for more information

Employer

What does COHE mean to you, the employer?

The Centers of Occupational Health and Education (COHE) work with you, medical providers, and your employee to help your employee return to work.  COHEs offer services to include:

• Medical providers trained in occupational health best practices.
• Timely referrals to medical specialists when appropriate.
• Health Services coordination.
• Return-to-work assistance.
• Telephone calls from a COHE medical provider.
• Telephone calls from COHE health services coordinators (HSCs).
• Claim notification.

Getting your employee back to work makes sense! Research shows that returning to normal activity as soon as safely possible after injury reduces the likelihood of long-term disability.  Helping your employees develop expectations and goals for returning to work can improve their outcomes while protecting their income and benefits and keeping your premiums low.  For more information on why returning to work quickly is an important part of your employee's recovery, click on the links below.

• Employer’s Return-to-Work Guide
• Early Return-To-Work
• Employer's Job Description (A fillable form - 95 KB PDF).
• Getting Back to Work: It's Your Job and Your Future (F200-001-000)  brochure for injured workers
• Talking points for return-to-work

For more information on a COHE in your area or the COHE success story, click on the following links:

COHE websites

• Renton COHE at (vmccohe.valleymed.org) at Valley Medical Center, Renton, WA.
• Eastern Washington COHE (www.goCOHE.com) at St. Luke's Rehabilitation Institute, Spokane, WA.
• The Everett Clinic (www.everettclinic.com).
• Harborview Medical Center.

Key results from the University of Washington evaluations of the COHEs.

• COHE met the goal for 3 out of 4 best practices: Report of Accident submitted in 2 days, use of the Activity Prescription Form, and provider call to the employer.
• 4.1 day reduction in time-loss days per claim, leading to a $480 net savings for medical and disability costs in the original evaluation years.
• $819 savings per claim in the Renton COHE and $1,279 in the Eastern Washington COHE and an average of a 9 day reduction in time-loss per claim when claims were followed for four additional years.
• For more COHE evaluation results go to the Research tab.

Where do I start? The Centers for Occupational Health and Education (COHEs) can help your employee get back to work and back to health.  If your employee’s provider is a COHE provider, he or she should be discussing your employee’s medical treatment plan and return-to-work options with your employee.  Verify if your doctor is part of a COHE. You may want to call the COHE medical provider, a COHE health services coordinator or your employee to start this conversation.

Other employer resources available from L&I:

• L&I Claims and Account Center (CAC):  http://www.lni.wa.gov/ORLI/LoGon.asp
  Secure access to the claim file for workers, providers, employers, vocational service providers, and others to whom an injured worker grants access. Also able to send secure email to the claim manager via this site. See “Common Questions” at this link for more information.
• What to do if your employees are injured.
• Help an injured worker get back to work.
• Prevent Injuries & Save Money.
• If An Injury Occurs.
• Earn a Claim-Free Discount.

Research

Key results from the evaluations of the COHEs

The University of Washington (UW), under contract from the Department of Labor and Industries, (L&I) has done a series of evaluations of the Centers of Occupational Health and Education. These evaluations include outcome evaluations, process evaluations, surveys and focus groups. In addition, L&I continues to capture ongoing performance measures of the COHEs in a quarterly scorecard. 

Key points from research on the effectiveness of the COHEs

• The COHEs have substantially prevented long-term disability, reducing costs by an average of $480 per claim and lost work time by an average of four days.
• These savings continue to accrue three to four years after the claim is filed, even though the COHE intervention occurs during the first 12 weeks of the claim.
• In the first year alone, the Renton and Eastern Washington COHEs together saved approximately $8 million compared to control groups. 

COHE Evaluations

UW evaluations and reports are listed below:

• Report on the Outcomes for Eastern Washington COHE, Expansion Counties - Task 9.

  Report on the Outcomes for Eastern Washington COHE, Expansion Counties - Task 9 (148 KB PDF) - May 2009. Report on the Outcomes for Eastern Washington COHE, Expansion Counties - This report provides new information regarding outcomes for injured workers treated within the 13-county expansion area (workers treated within the original 3-county target area are not included).

  • Little change in outcomes over time for the COHE injured workers relative to the comparison-group.
  • COHE providers who adopted best practices more often had significantly fewer time loss days compared to injured workers treated by COHE providers who adopted best practices less often.
• Report on the Outcomes of the Original COHEs' Later Cohorts - Task 4 and 5

  Report on the Outcomes of the Original COHEs' Later Cohorts - Task 4 and 5 (152 KB PDF) - November 2008. - This analysis evaluates outcomes using new COHE cohorts representing injured workers treated more recently during evaluation years three and four.  The report examines three outcomes: (1) time loss days, (2) time loss payments, and (3) medical costs.

  • 4.1 day reduction in time-loss days per claim, leading to a $480 net savings for medical and disability costs in the original evaluation years.
• Process Evaluation of the Harborview Medical Center Seed Center of Occupational Health and Education - Task 7A

  Process Evaluation of the Harborview Medical Center Seed Center of Occupational Health and Education - Task 7A (104 KB PDF) - November 2008. A process evaluation of the seed Center of Occupational Health and Education at Harborview Medical Center consists of key informant interviews and analysis of several administrative data process measures.

  • The percentage of claims filed within 2 business days increased rapidly and by 2008 about 65% of claims were submitted within 2 business days.  Before the Harborview seed intervention began in July 2006, less than 10% of accident reports were submitted within 2 business days.
  • According to an L&I Claims Supervisor: Getting the ROA’s more quickly from HMC is “like tearing down the Berlin Wall!”
• Report on the Health Care Provider, Office Staff and Employer Focus Groups - Task 6

  Report on the Health Care Provider, Office Staff and Employer Focus Groups - Task 6 (104 KB PDF) - July 2008. This report summarizes a series of focus groups with COHE providers, provider office staff and employers.

  • High provider, employer and worker satisfaction.
• Long-Term Follow Up of Original COHE Cohorts (98 KB PDF) - March 2008.

  Long-Term Follow Up of Original COHE Cohorts (98 KB PDF) - March 2008. This report summarizes the results of an analysis conducted by the University of Washington research team to evaluate the effects on disability and costs associated with the Centers of Occupational Health and Education (COHE) over an additional 2-3 year follow-up period.

  • $819 savings per claim in the Renton COHE and $1,279 in E WA COHE and an average of a 9 day reduction in time-loss per claim when claims were followed for four additional years.
• Centers of Occupational Health and Education - Summary Findings (724 KB PDF) - December 2007.

  Centers of Occupational Health and Education - Summary Findings (724 KB PDF) - December 2007. This document incorporates high level findings from multiple formal outcome evaluations and ongoing process and performance evaluations conducted for the Occupational Health Services project. The results are presented in measures related to access, quality, and cost. Evaluation and scorecard performance dates and data sources are noted for each measure.

  • Fewer rejected claims, fewer protests and appeals, less use of attorneys, and lower pension rates.
• Centers of Occupational Health and Education (285 KB PDF / 1 min) - April 2007.

  Centers of Occupational Health and Education (285 KB PDF / 1 min) - April 2007. This is a final report on outcomes from the initial cohort of injured workers, 2003-2005 (Western Washington and Eastern Washington).

  • 73% of the estimated cost savings in Renton and 52% of the cost savings in Spokane resulted from reduced moderate and long term disability.
  • Our estimate of COHE cost savings increased substantially from $401 to $572 per claim
• Eastern Washington COHE Evaluation Report (211 KB PDF / 1 min) - October 2007.

  Eastern Washington COHE Evaluation Report (211 KB PDF / 1 min) - October 2007. This report outlines the success of the COHE pilot project in reducing disability while maintaining high worker satisfaction.

  • For all cases treated in the evaluation year, COHE injured workers, including those with back pain diagnoses, had lower incidence of (time loss) disability: 13.7% versus 20.2%. 
  • COHE compensable back sprain cases treated by “high volume” providers were less likely to be on disability 365 days after claim receipt: 2.2% versus 14.0%.
• Western Washington COHE Evaluation Report (139 KB PDF / 1 min) - June 2005, revised April 2007.

  Western Washington COHE Evaluation Report (139 KB PDF / 1 min) - June 2005, revised April 2007. This report outlines the success of the COHE pilot project in reducing disability while maintaining high worker satisfaction.

  • A smaller proportion of COHE compensable cases were on time loss at 180 days: 16.8% versus 21.5%.
  • COHE patients were 55% more likely to return to work for the employer of injury.
  • Aggregate net savings were $383 per COHE claim.

  L&I provides quarterly COHE scorecards

  Link to scorecard measures

  • COHEs consistently met the goal for 3 of 4 best practices: ROA in 2 days, use of the Activity Prescription Form (APF), and provider call to the employer. 
  • A 13-day reduction in the time to determine validity of a COHE claim and provide worker benefits.

  Research and background regarding COHE project

  • Bibliographies.
  • White Papers.
  • Historical Documents.
    

Future Plans

Plans for COHE's Future

The COHE project is now about 10 years old and has demonstrated significant success.  L&I recently engaged the Workers’ Compensation Advisory Committee Healthcare Subcommittee (WCAC-HC) in a formal collaborative process to determine a roadmap to the future.  While COHE results have been positive, all parties want to make sure that any expansion is done in a deliberate way that enhances success and effectively manages costs.

• COHE Development Work Plan 2009-2013 (458 KB PDF) October 2009.