IR #2002-19
Thursday, December 19, 2002

Richard Stephens

DWC certifies Blue Cross affiliate as the state's
newest and largest HCO network to date

SAN FRANCISCO - The California Department of Industrial Relations Division of Workers' Compensation (DWC) certified the state's newest health care organization (HCO), BC Life and Health Insurance Company-an affiliate of Blue Cross of California-offering employers and insurers another cost effective way to provide quality medical treatment for workers injured on the job.

"The addition of BC Life and Health brings what may be the largest health care provider network in the state into the HCO program," said DWC Administrative Director Richard Gannon. The BC Life and Health (BCLH) plan will be known as the Prudent Buyer HCO.

BCLH will utilize the provider network of its affiliate, Blue Cross of California, to provide workers' compensation medical services to employers and injured workers. Covering nearly 99 percent of all zip codes in California, the Blue Cross network has over 40,000 providers, a group of which will comprise the core of BCLH's occupational health network for treating injured workers.

BCLH will begin marketing the Prudent Buyer HCO plan to its existing clients in early 2003.

"HCOs are an increasingly popular way to help employers and workers improve medical care quality and early return to work programs while controlling rising workers' compensation costs," said Gannon. "Prudent Buyer and other newly certified HCOs are substantially increasing the options businesses have -- and the choice employees have -- for using these plans to treat work related injuries," he said.

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.

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, and must report data on medical treatment patterns, costs and outcomes for patients receiving HCO care to the DWC annually.

Employers previously had to offer employees a choice of at least two HCOs but new regulations that go into effect Jan. 1, 2003 allow employers to offer employees only one.

Blue Cross of California and BC Life & Health Insurance Company are independent licensees of the Blue Cross Association.

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A list of certified HCOs can be found on the DWC Web site at'_Compensation/DWC/HCO.htm