This project is exploratory and focused on evaluating feasibility. No decisions regarding implementation have been made.
This project is exploring whether elements of the COHE program could be applied within Washington's self-insurance system. The goal is to better understand whether COHE best practices could support workers employed by self-insured employers in their recovery and return-to-work. Through collaboration with self-insured employers, third-party administrators, COHE representatives, and L&I best practices staff, this project will evaluate operational considerations and determine whether integration is feasible.
COHE: what is it?
Centers of Occupational Health & Education (COHE) are community-based programs partnering L&I with health care organizations to improve medical and work recovery outcomes and reduce work-related disability.
The COHE program has demonstrated positive outcomes in Washington's state-fund system, including:
- Reduced disability days: COHE has led to nine fewer disability days on average per claim, boosting recovery and return-to-work efforts.
- Improved claim outcomes: participants have seen fewer rejected claims and protests.
- Lower claim costs: claims involving a COHE participating provider have shown approximately 18% lower costs.
For more information on COHE please visit our COHE webpage.
Current Activities
In April 2026, we launched a work group with participants from L&I, COHEs, self-insured employers, and third-party administrators to evaluate the best way to integrate COHE and self-insurance. The end goal is for all workers to have equal access to best practices that support recovery and a safe return-to-work. Some of the critical discussion topics include:
- Health services coordination and third-party administrators' processes,
- Communications,
- Data sharing and reporting, and
- Financial structures
Meeting Agenda
Meeting Materials
Background Documentation
COHE and the legislature
The COHE program was launched in 2002 and codified in legislation in 2011 (RCW 51.36.010). The program has expanded to seven COHEs, with nearly 98% of state-fund workers in Washington living within 15 miles of a participating provider.
King county pilot
In 2012, we started a three-year pilot. King County, a self-insured employer, and the COHE at UW Valley Medical Center piloted health services coordination for patients at the Occupational Health Services clinic. The goal was to improve worker care and return-to-work, with a focus on health services coordination. We learned a lot from that experience! The biggest pilot challenges were communication barriers and disconnected technology systems.
Internal assessment
An internal assessment was completed in 2025 and it has helped identify key information gaps and opportunities for deeper engagement with self-insured employers and third-party administrators. We were able to identify 68 gaps that included claim processes, education and training, and needed resources. Many of the gaps pertained to:
- Health services coordination, administration, and documentation,
- Best practice tracking and measurement,
- Provider reporting and quality improvements, and
- Technology to support COHE activities.
Frequently Asked Questions
Any implementation will be impacted by the availability of resources and our work with self-insured employers.
Yes, we have a small group of COHE, self-insured employers, third-party administrators, and L&I staff who would love to hear from you. Please send your questions and comments to COHESIPROJECT@Lni.wa.gov.