EK HEALTH

SAN JOSE, Calif.--While lawmakers debate whether California utilization-review physicians should hold a California medical license (AB 933), one company specializing in workers’ compensation utilization review (UR) is ahead of the curve.

Currently, an in-state license is not required to perform UR in California, and many UR companies are using doctors not licensed in the state.

EK Health Services, founded in 1998, began providing UR services to California’s workers’ compensation insurers in 2004 as part of a legislative mandate, and maintains a policy of contracting solely with California-licensed physicians. The company has exclusive contracts in California with nearly 100 physicians throughout the state.

According to Eunhee Kim, company founder and president, EK Health built its UR model on hiring physician reviewers who, in addition to being California licensed, maintain active medical practices in specialties associated with work injuries. Its physicians are experienced in applying defensible, evidenced-based medicine to medical treatment in their specialty.

“We believe physicians with these credentials are in a better position to offer quality reviews relevant to California,” she said. “They understand the state’s unique regulatory requirements. They see medical cases from all points of view, including the injured worker, the treating physician, the employer and the role of UR.”

EK Health’s UR panel consists of physicians experienced in workers’ compensation related injuries, including occupational medicine, pain management, physical medicine and rehabilitation, orthopedics and neurosurgery.

Richard Thompson, M.D., EK Health’s Chief Medical Officer, said meaningful and timely communication between UR and treating physicians is often essential to providing cost effective, timely and appropriate medical treatment that promotes quality healthcare and return to work.

Because workers’ compensation UR must be provided within mandated timelines, access to treating physicians is important, said Thompson. “This is often difficult to accomplish if the doctors work in different time zones.”

Regardless of whether there is a case under review, EK Health makes on-going communications with its physicians a priority. “As independent contractors, our physicians make their own decisions,” said Thompson. “Our job is providing them resources to apply best practices and principals of defensible, evidence-based medicine in treating injured workers, and to facilitate the administrative process.”

While some California industry groups say mandating in-state medical licenses for physician utilization reviewers adds costs, EK Health takes a different view. “Cost containment comes from quality UR,” said Thompson. “Unnecessary treatment is where the expense comes in, not through quality UR.”

Headquartered in San Jose, CA, EK Health Services is one of nation’s leading medical and disability management services companies, providing case management, utilization and peer review services to insurance companies, employers, for-profits and public entities, including California’s State Compensation Insurance Fund.