DWC Approves Three New "24 Hour Care" Pilot Projects

SAN FRANCISCO--Three additional "24 hour care" pilot projects, which allow employers to offer employees an integrated health care plan covering both general health care needs and medical treatment for work-related injuries and illnesses, will be underway this month, DIR Director Lloyd W. Aubry, Jr. announced.

The pilot projects will operate in San Diego, Los Angeles, Sacramento and Santa Clara Counties. A fourth pilot project, conducted by Kaiser Permanente in San Diego County, has been in operation since May, 1994.

"Under the '24-Hour' Coverage concept, all of a participating employee's health care needs, including job related injuries covered under workers' compensation insurance, are provided by one exclusive provider of health care services," Aubry said.

"Traditionally, many employers offer a health care plan as an employee benefit, providing for the general medical needs of workers and their families. In addition, every employer in the state must also provide coverage for work-related injuries, either by having a workers' compensation insurance policy or by receiving approval to self-insure their liabilities," Aubry said.

Employees who opt to participate will benefit by having the same doctor or medical facility care for all of their medical needs, thereby assuring access and continuity of care. Medical treatment provided for work related injuries will continue to be provided without coinsurance, deductibles or premium copayment by employees. Employers are expected to benefit from lower costs, as administrative duplication is eliminated.

The three new pilot projects approved by the Department of Industrial Relations' Division of Workers' Compensation are:

* Sharp HeathCare and TIG Insurance Co., which have developed a 24-hour care product to be sold primarily to San Diego's small employers. Officially named "The 24 Hour Care Alliance," this pilot utilizes the Sharp Rees-Stealy Medical Group's dedicated occupational medicine approach to managing workers' compensation medical and disability costs.

* Kaiser Permanente's Northern California region, which is inaugurating a program covering both public and private sector employees in Sacramento and Santa Clara Counties. The first participant's in this pilot are a fruit packing company in Santa Clara County and an auto dealership in Sacramento County. The State of California, as an employer, is considering participating in this program.

* Maxicare Life and Health Insurance Company, which has established a network of doctors and medical groups in Los Angeles County, trained in both occupational and non-occupational medicine. This approach differs from the other pilot programs in that a patient initially sees the same primary care physician for all types of injuries. In the other pilots, a patient with a workers' compensation injury may first be required to see a physician at the facility who specializes in occupational medicine. It is anticipated that both large and small private sector employers in the county will participate in this program.

The three-year pilot programs are among the first in the nation to test this innovative approach. They were authorized by Assembly Bill 3757, enacted in 1992, and AB 1692, enacted in 1993. Several insurers have indicated that participating employers could be eligible to receive a reduction in their workers' compensation insurance premium rates.

At the end of the three-year period, a study will be completed which reviews employer costs and other aspects of this innovative approach to medical care delivery.

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