Disease Management

Support for Managing a Chronic Condition 

Western Health Advantage members may access what is often called Disease Management programs at no additional cost. The programs offer members living with chronic illnesses, added support and resources to manage and control their condition.

The program is managed through our health solutions partner, Optum Health, and focuses on the following chronic illnesses: asthma, coronary artery disease, and diabetes (both type 1 and type 2). In 2024, WHA added Chronic obstructive pulmonary disease (COPD) and Congestive heart failure (CHF). If you have one or more of these chronic illnesses, chances are your doctor has already discussed some of the related health risks of these conditions:

  • Asthma: Asthmatic attack or some other respiratory illness (for members ages 5+ years)

  • Coronary Artery Disease (CAD): Heart attack or stroke (for members ages 35+ years)

  • Diabetes (type 1 or type 2): loss of eyesight, kidney disease, or heart disease - see also our diabetes management webpage - (for members ages 6+ years with diabetes)

  • Chronic obstructive pulmonary disease (COPD): is a chronic inflammatory lung disease that causes obstructed airflow from the lungs; (for members 40+ years with COPD)

  • Congestive heart failure (CHF): when your heart muscle is weak and does not pump blood as well as it should, (for members ages 18+ years with CHF)

In addition to expanding care to chronic conditions such as COPD and CHF, we're offering enhanced, Remote Patient Management. This service is intended to help you and your care team keep track of how you are doing more regularly, instead of just relying on your next doctor’s appointment or scheduled home care visit. 

This is your next step in advancing care and it's included in your WHA plan!  WHA members can access services and the tools to help them manage their health more effectively - which may include mobile phone apps, helpful tips, educational videos, and simple encouragement and coaching on how to maintain your best possible health and outcomes. 

How to Become a Participant in WHA's Disease/Chronic Condition Management Program

Self-referral: Members can contact Optum directly (877.793.3655), or contact WHA's member services, or complete an online chronic care/condition management referral form.

Physician Referral: Your doctor can refer you directly WHA or Optum or complete the online chronic care/condition management referral form

Medical Group or IPA Case Manager Referral: Case managers or utilization management nurses can refer directly to Optum or to WHA's member services.

How to Use the Program

The care manager fosters the patient-doctor relationship by encouraging participants to communicate with their doctor about any changes to their health. Well-trained care managers help participants understand the importance of adopting healthy habits that prevent or limit complications. Participants can take advantage of this service by actively participating in the program, and by knowing their lab results, blood pressure, and the dates of their recent office visits.

What the Program Offers

An initial evaluation to help the nurse decide whether the person is at a high or low risk of developing complications from the disease.

  • High-risk participants:

    • Receive health education materials related to their condition

    • Are assigned a care manager

    • Schedule calls agreed upon by the participant and the care manager

    • Receive coaching and support by well-trained health improvement experts, including nurses and specialists

  • Low-risk participants:

    • Receive health education materials specifically related to their condition

    • Get access to a care manager who will answer questions about their condition, medications, tests or how to best manage their care

How the Program Works with You and Your Doctor

The design of the program is to work with the treatment plan developed by your doctor and by:

  • Providing information about the disease for a better understanding of the condition

  • Reinforcing the importance of taking prescribed medicine as instructed by the doctor

  • Encouraging participants to complete tests and preventive services

  • Reminding participants about the importance of follow-up visits with their doctor

  • Discussing healthy nutrition and physical activity

  • Advising about community resources

  • Sending alerts and progress reports to the doctor that may include recommended treatments or services based on national standards

For more information about WHA's Disease/Chronic Condition Management programs, contact WHA Member Services. You may also contact Optum at 877.793.3655, Monday through Thursday, 9 a.m. to 7 p.m., Friday and Saturday, 9 a.m.p.m.; closed holidays.

Click here for WHA's Chronic Care/Condition Management form. 

Last review date: December 7, 2023