Disease management is a multidisciplinary approach to addressing chronic conditions. It allows a health plan and physician to work together to improve a patient's quality of life and reduce the number of complications from a chronic condition.
The programs are managed by Optum®, a National Committee for Quality Assurance (NCQA) accredited disease management organization, and overseen by WHA.
Depending on the severity of your illness, health care professionals may contact you by telephone and/or send you educational mailers related to your condition. Health professionals coach participants on nutrition, medication management, physical activity and community resources. In addition, your health care provider receives progress reports that may include patient-specific and evidence-based treatment recommendations that allow your physician the opportunity to make any appropriate adjustments to your current plan of care.
WHA identified the following chronic conditions as having the most impact on the health of our commercial members and included them in our disease management programs:
Asthma 5-56 years
Coronary Artery Disease (CAD) 18-64+ years
Diabetes 18-64+ years
If your health care provider told you that you have diabetes, coronary artery disease (CAD) or asthma, you probably already qualify. Discuss the benefits of enrolling in one of the programs with your healthcare provider or contact Optum® directly.
WHA provides this service as a benefit to our commercial members so there is no additional cost to participate in the program.
Not at all. The programs are voluntary and are available to help those living with specific chronic conditions and to prevent complications that can be life threatening.
No. Employers are not informed which of its employees are enrolled in our disease management programs. Specific employer groups receive general, statistical reports. However, these reports do not include information that specifically identifies individuals.
Members are enrolled using several methods.
Claims data: WHA provides Optum with monthly claims information generated by our medical group in compliance with HIPAA privacy standards. WHA's health care providers are aware of the agreement between WHA and Optum® and receive updates on their patients' progress.
Self-referral: Members can self-refer by completing the WHA Disease Management Program Referral Form and faxing the form to 916.568.0278 or mailing to WHA at 2349 Gateway Oaks Drive, Suite 100 Sacramento, CA 95833, Attention: HPDM Department.
Contacting WHA directly: Members can call WHA's Member Services department toll-free at 888.563.2250 Monday through Friday between 8 a.m. to 5 p.m. and ask to speak to an HPDM representative about enrolling in our Disease Management Program.
Contacting Optum® directly: Members can call Optum® and speak to one of their enrollment representatives at 877.793.3655.
Information such as your name, gender, date of birth, phone number, diagnosis and any other information that helps to administer their programs.
Optum complies with all applicable provisions of law relating to the privacy, confidentiality, security, integrity, transmission or exchange of medical, personal, consumer or financial information obtained and maintained by Optum.
Optum is a business associate of WHA and is a covered entity under the HIPAA Privacy and Security Rules. Optum does not use or disclose Protected Health Information (PHI) for any purpose other than as required to perform its agreements with health plans or as otherwise required or permitted by law. Optum uses appropriate safeguards consistent with reasonable practices in the industry to ensure that PHI is not otherwise used or disclosed.
Optum® currently uses the information we collect in the following areas:
To create general, statistical reports. These reports do not include information that would specifically identify individuals. For example, a report might include such facts as 55 percent of participants have diabetes or 20 percent of participants are receiving telephone contacts.
For other business purposes such as sending you educational mailings, questionnaires, periodic health reminders or other information.
Optum will not contact you via email without your permission except as specified above, or in response to messages sent to our healthcare team through our message system, or in connection with the registration process.
Optum will never release, sell, rent, or otherwise provide any personally identifiable information on any users to any third party, except as set forth in this policy, without your express permission to do so.
Yes. The programs are voluntary and members can choose to "opt in" or "opt out" at any time. Simply contact Optum® or WHA and let them know which program you would like to enroll in or that you no longer wish to be a participant.
WHA oversees the disease management services while Optum® makes the necessary contacts by mail and/or phone depending on the severity of the participant's illness
You can address any concerns or complaints to WHA. Formal complaints or grievances must be in writing. Direct your general questions or concerns to one of our Member Service Representatives.