Disease Management

Western Health Advantage members have access to Disease Management Programs (also known as chronic care/condition management) at no additional cost. The programs offer members living with a chronic illness resources to help manage and control their condition. The programs are managed through our health solutions partner, Optum™, and focus on the following chronic illnesses: asthma, coronary artery disease, and diabetes.

If you have one or more of these chronic illnesses, chances are your doctor has already discussed some of these related health risks.

  • Asthma: Asthmatic attack or some other respiratory illness

  • Coronary Artery Disease (CAD): Heart attack or stroke

  • Diabetes: Loss of eye sight, kidney disease or heart disease


How to Become a Participant in a Disease Management Program

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

Physician Referral: Your doctor can refer directly to 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 Programs Offer

An initial evaluation to help the nurse decide whether the person is at high-risk or low-risk for 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 programs 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 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, 9a.m. to 6p.m. PST; closed holidays.

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

Last review date: October 30, 2020

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