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Disease Management

 

As your health plan, we are especially concerned about those who are living with or have been newly diagnosed with a chronic condition. When you learn more about your particular condition and are actively involved in managing your care, you are more likely to be successful in preventing complications. This is particularly true when you, your doctors, and your health plan work together toward the same goal to help you stay well.

Through our partnership with Optum®, a disease management (DM) organization accredited by the National Committee for Quality Assurance (NCQA), WHA offers DM Programs to members living with the following chronic conditions at no additional cost:

  • Asthma (ages 5+)
  • Congestive Heart Failure (CHF) (ages 18+))
  • Coronary Artery Disease (CAD) (ages 35+ years)
  • Chronic Obstructive Pulmonary Disease (COPD) (ages 40+ years)
  • Diabetes (ages 6+ years) – learn more about our diabetes support
  • High-Risk Maternity (ages 18+ years) — learn about the pregnancy program

The DM Programs are voluntary and participants can choose to dis-enroll or "opt-out" at any time by contacting Optum at 877.793.3655 or contact WHA Member Services.

There are several ways to participate in a DM Program:
  • Referral to WHA or Optum by the primary care physician (PCP) or specialist.
  • Referral from the medical group or IPA Case Management or Utilization Management staff.
  • Self-referral from members by contacting Optum or WHA directly download and submit a disease management referral (PDF) form.
Programs included in your membership

The programs offer services based on how well the disease has been managed up until the time of enrollment. An initial evaluation helps the DM nurse decide whether the participant is at high-risk or low-risk for developing complications from the disease. The types of service provided are based on the risk levels:

  • High-Risk: Participants receive health education program materials related to their condition, telephone calls, coaching, and support by health care professionals as well as health education program materials.
  • Low-Risk: Participants do not receive calls but do receive health education program materials.

Once you qualify for a program, you will receive health education materials specific to your condition. You will also have access to a DM care manager who will answer questions you may have about the disease or about how best to manage your care.

If you are at high-risk for complications, you qualify to receive regular calls from your assigned care manager during an agreed upon day and time. During these calls, you can ask questions about nutrition, exercise, medications, and more. The care manger acts as your coach in reinforcing your treatment plan created by you and your doctor. The care manager is well trained in helping those who participate in the programs to understand the importance of adopting healthy habits that prevent or limit complications.

Most importantly, the care manager will foster the patient-doctor relationship by encouraging you to communicate with your doctor about any changes you may be experiencing in your current health status.

*Coverage for this program depends on certain eligibility criteria. WHA Medicare Advantage members are not eligible for this program at this time. 

How the Programs Work with You and Your Doctor

The programs are designed to work with the treatment plan developed by your doctor. The DM Programs are staffed by well-trained experts in health improvement who consist of nurses, specialists, and coaches to help you manage your chronic illness by:

  • Educating you about the disease so you have a better understanding about your condition
  • Reinforcing the importance of taking your medicine as recommended by your doctor
  • Encouraging you to complete those all-important lab tests and preventive services
  • Reminding you about the importance of follow-up visits with your doctor
  • Discussing healthy nutrition options and physical activity
  • Advising you about community resources
  • Sending alerts and progress reports to your doctor that may include recommended treatments or services based on national standards

For more information about our Disease Management Programs, contact WHA Member Services and ask to speak to a Health Promotion & Disease Management representative.

You may also contact Optum directly toll free 877.793.3655, Monday through Thursday, 9 a.m. to 7 p.m., Friday and Saturday, 9 a.m. to 6 p.m. PST; closed holidays.