The Spokane-based Eastern Washington Center of Occupational Health & Education is broadening its service area with the addition of Benton, Franklin, and Kittitas counties.

Daniel Hansen, Eastern Washington COHE director, says the program recently signed a three-year contract that includes renewal options with the Washington state Department of Labor & Industries to serve a total of 19 counties in Eastern and Central Washington. The contract, which can be renewed for a total of nine years, is part of a permanent L&I program that now includes six COHE programs statewide.

COHE programs strive to help injured workers get back to their jobs as quickly as possible by using health-services coordinators, participating health care providers who follow COHE guidelines, and case-tracking.

St. Luke's Rehabilitation Institute, a division of Inland Northwest Health Services, sponsors the Eastern Washington COHE program.

Hansen says the program's latest contract has a new provision that enables the program for the first time to work directly with employers that self-insure for their workers' compensation claims. With the allowance, Hansen says large employers, including Costco Wholesale Corp., are exploring the possibility of contracting with the program here.

Katrina Zitnik, Issaquah, Wash.-based director of workers' compensation for Costco, says the advantage of working with the program would be having access to coordinators who talk directly with L&I and coordinate cases to return workers to some job functions after an injury.

"It's proven to be a good concept," Zitnik says. "We're interested in exploring it."

She adds that any such options for Costco's operations in Washington state likely also would include tapping into other COHE programs.

"L&I is very open to working with self-insurance employers to find ways to include them in COHE," she says. "We understand they have developed a statewide system for COHE. If we can integrate with that, we would want to make sure our employees could go to any provider throughout the state."

In addition to the Eastern Washington COHE program in Spokane, other COHEs are located in Seattle, Tacoma, Everett, Renton, and statewide under a program operated by Seattle-based Group Health Cooperative.

With the Eastern Washington COHE program's expansion, it expects to hire three additional health services coordinators between this fall and next spring, bringing its total number of employees to 14. Hansen says the first hiring for coordinator positions this fall will include adding one person in Yakima and another for a Kennewick satellite office, which the program expects to open by Oct. 1.

"We'll eventually hire another health services coordinator by spring who also will work in Kennewick," Hansen says.

The COHE here started as part of a pilot program in 2003 serving Spokane, Grant, and Stevens counties. The COHE program in Renton also started that year under the pilot project. In 2005, the Eastern Washington COHE program expanded into 13 other Eastern Washington counties, Hansen says.

He says that for Eastern Washington COHE locations outside of Spokane, the program rents a small amount of space from L&I offices, including in Yakima and Wenatchee, as well as another space soon in Kennewick.

The program's Spokane office is located in the Wells Fargo Financial Center, at 601 W. First, which is owned by Inland Northwest Health Services, St. Luke's parent.

In 2011, then-Gov. Chris Gregoire signed into law Senate Bill 5801 directing L&I to create a statewide COHE system as a permanent program. By then, the COHE program effectively had showed an impact in cutting state workers' compensation costs and supporting employees' return to work more quickly, Hansen says.

Literature for the COHE program claims that injured workers treated by a provider following COHE guidelines have 20 percent fewer days off than other injured workers, and that claim costs averaged $510 less per worker across all COHE programs.

Hansen says the Eastern Washington program handles more than 19,000 claims annually and works with more than 1,200 participating health care providers. He says it operates here under a $1.3 million annual budget funded by L&I.

He adds that in the 16-county Eastern Washington service area, if someone is injured on the job and seeks care, almost 80 percent of those cases will be monitored by a COHE provider.

Group Health signed with L&I this past summer to begin operating a COHE program for its facilities statewide, which means its Eastern Washington clinics and affiliated clinics of Columbia Medical Associates here will operate in a separate system from the Eastern Washington COHE program, Hansen says.

"For Spokane, Group Health will also have a presence that is going to be its own institutional COHE, and since they have affiliation with Columbia, they will move from our COHE into the Group Health COHE," Hansen says.

Prior to this change, a Group Health occupational medicine office here had one provider in Spokane participating in the Eastern Washington COHE program for about a year, he says. Columbia, a Spokane-based physicians' group that Group Health acquired in 2011, has about 15 clinics and 32 providers who have participated in the COHE program here, but won't under the change, Hansen says.

He says he doesn't view the separate Group Health program as competition.

"I see it as a community solution, so even more people can have access to quality care," Hansen says, adding that Group Health likely will develop and expand its COHE system to include streamlining its urgent care facilities with follow-up care by physicians at its clinics. "A lot of labor employees have insurance with Group Health, so there's the continuity of care," he says.

Meanwhile, the new option to work with large employers that are self-insured might open the door to public municipalities, and potentially exploring pilot programs with some federal employers with offices in Eastern Washington, Hansen says.

He says a representative with Burlington Northern Santa Fe Railroad operations in Washington state has approached the COHE here to discuss potentially developing a pilot program for some of its workers.

Hansen says that the Eastern Washington COHE program has worked closely with businesses on this side of the state and now serves nearly 800 participating employers.

"We've always valued our relationship with the business community," he says. "We look forward to continuing to work with them for the next nine years."