The UW Medicine Accountable Care Network provides eligible Washington State employees with access to high-quality, excellent service and affordable healthcare. The following Q&A will help you understand the details and benefits of your new healthcare option.
An accountable care network is a group of healthcare professionals and organizations that join together to provide affordable, high-quality healthcare.
An Accountable Care Network gives you access to a coordinated team of healthcare providers for primary care, urgent care and specialty care. Primary care providers focus on wellness and disease prevention. When referrals to specialists are needed, your providers closely communicate and coordinate your care to achieve the best possible outcomes. PEBB has called this model an “accountable care program” (ACP) and offer two UMP Plus options under this model to eligible public employees.
The UMP Plus network options focus on making healthcare more affordable and keeping people well with preventive and better coordinated care so they don’t develop more serious or chronic conditions. The state’s choice to offer these options aligns with the PEBB program’s commitment to providing high quality medical benefits for PEBB members. It also ties back to the state’s “Healthier Washington” initiative, which seeks to help people receive better and more affordable healthcare throughout their lives.
The UMP Plus – UW Medicine Accountable Care Network is currently available to PEBB benefits-eligible members who live in Grays Harbor, King, Kitsap, Pierce, Skagit, Snohomish or Thurston counties, including:
The UMP Plus – UW Medicine Accountable Care Network includes many of the region’s finest healthcare organizations. All share a commitment to high-quality, affordable care as well as excellent patient service and access to care. The network currently includes the following organizations:
Please check with your benefits administrator or human resources department for more information on monthly premiums and any other costs associated with the UMP Plus options.
Patients who are currently seen at one of the UMP Plus – UW Medicine Accountable Care Network facilities will continue to receive the same high-quality care they receive today, regardless of their chosen benefits plan.
If you choose the UMP Plus – UW Medicine Accountable Care Network as an option, you will have access to services and benefits such as:
The UW Medicine Accountable Care Network (UW Medicine ACN) brings together the skills, services, and geographic reach of exceptional healthcare organizations throughout the Puget Sound region to offer a complete range of services, available within a single network, from preventive and primary care to advanced specialty care.
By selecting the UW Medicine ACN, you will have access to:
Additional benefits include:
And if you should need specialty services, our teams provide the following:
In addition, the UW Medicine Accountable Care Network emphasizes shared decision making between you and your provider about your preventive health and any chronic or acute health conditions that may require coordination with multiple specialists.
The UMP Plus – UW Medicine Accountable Care Network uses the medical home model, where a patient’s healthcare is managed by a team of professionals working in close coordination with a primary care physician. By employing evidence-based preventive measures, these teams identify and treat underlying health problems before they become chronic conditions. And with more integrated data and information-sharing, each member of the team also has greater access to the latest information about every patient. This model of care is especially important for patients with chronic conditions – such as heart disease or diabetes – that often require work with multiple specialists. This model enables integrated, coordinated scheduling and communication with patients, as well.
The UMP Plus – UW Medicine Accountable Care Network offers access to a broad network of experienced pediatric providers and clinics, along with some of the best pediatric hospitals in the nation, including both Seattle Children’s Hospital and Mary Bridge Children’s Hospital.
The UMP Plus – UW Medicine Accountable Care Network provides the most advanced cancer care available, with comprehensive services that include expert diagnosis, surgical services, medical and radiation oncology, education and support. Several internationally renowned cancer care providers are members of the network, including the Seattle Cancer Care Alliance (SCCA), a world-class cancer treatment organization that is a partnership between UW Medicine, Fred Hutchinson Cancer Research Center and Seattle Children’s Hospital. SCCA patients have access to the latest cancer treatments including stem cell and bone marrow transplantation, gene therapy, high-dose chemotherapy, radiation therapy, immunotherapy, proton therapy, minimally invasive surgical techniques and other specialized therapies.
The UW Medicine ACN Virtual Clinic provides patients with healthcare from the comfort of home, office or other location. It is offered to enrollees in the UMP Plus – UW Medicine Accountable Care Network option at no cost.
The clinic is available any time of the day or night, whenever you need it. During a virtual clinic visit, a board-certified family practice doctor or nurse practitioner provides assessment and treatment for an urgent care issue over the phone or through a webcam on your smartphone, tablet or computer. Visits typically last about 20 minutes.
The virtual clinic provider can recommend home care options, suggest over-the-counter treatments, write a prescription, direct you to an urgent care facility or the ER if necessary, and help you find a convenient pharmacy.
Choosing a primary care provider is always recommended, but it is not required under the UMP Plus – UW Medicine Accountable Care Network. Primary care providers are familiar with your health history and are the “first responders” to your healthcare needs. They are important in coordinating your care with other providers, procedures and services. When you sign up for the UMP Plus – UW Medicine Accountable Care Network, you will have many options for selecting a primary care provider who meets your health needs and is convenient to where you live or work.
No, you do not need a referral to see a specialist. In order to receive network-level benefits, the specialist must be in the UMP Plus – UW Medicine Accountable Care Network. However, we recommend working with a primary care provider to receive the most benefit from the coordinated care that the network offers.
We encourage patients to stay within the Network to minimize their out of-pocket expenses. If you receive non-emergency services from providers outside the network, you can expect to have higher copays and/or deductibles. If you plan to see a new provider or if your primary care provider refers you to a specialist, it’s a good idea to make sure those providers are in the network before you proceed with your appointment. If the service you need is not available in the network and if your in-network provider believes it is in your best interest to see an out-of-network provider, he or she can request a network waiver before out-of-network services are performed. As a reminder, there are two UMP Plus plan options. To make sure your provider is in the UMP Plus – UW Medicine Accountable Care Network, visit uwmedicine.org/umpplus or call 855-520-9500.
Yes. You and your family members may use as many different facilities and providers within the UMP Plus – UW Medicine Accountable Care Network as are necessary for your care. The UW Medicine Accountable Network offers complete care, from primary to specialty to highly complex. It also covers a wide geographic area that will be easily accessible and convenient to the homes and offices of eligible public employees in the seven covered counties. No matter where you and your family members choose to get care within the network, we recommend working with a primary care provider to receive the most benefit from the coordinated care the network offers.
You may search a database of network providers, clinics or hospitals by visiting uwmedicine.org/umpplus. You may also search a database of primary, specialty and ancillary providers at regence.com. Or you may call the dedicated contact center at 1-855.520.9500.
Ancillary providers are certain types of providers who may be within your UMP Plus network because they are a Regence network provider.
Following are examples of ancillary providers:
A full list of ancillary services and providers is available at regence.com.
You may search for ancillary providers by visiting the provider search on the UMP Plus – UW Medicine ACN portal and clicking on “additional providers” to link through to the correct location on regence.com. You will receive network-level benefits for UW Medicine ACN affiliated providers as well as providers contracted with Regence.
You will have the same access to your medical records as you do today.
If your current provider is already in the UMP Plus – UW Medicine Accountable Care Network, you do not have to do anything. If your provider is not part of the network, your records will not be transferred automatically. We recommend contacting your current provider, who will ask you to fill out a “release of information” form. On this form, you can indicate where you would like your records transferred.
Patient privacy is critically important to each healthcare organization in the UMP Plus – UW Medicine Accountable Care Network. Your medical records are available only to those healthcare providers within our network who are directly involved in your care, and those records are protected by stringent privacy regulations.
New employees can sign up as they become eligible for benefits. All other eligible employees must sign up during the annual open enrollment period of November 1-30, 2016 for the 2017 plan year.
Coverage under plans chosen during the open enrollment period (November 1 – 30, 2016) begins January 1, 2017.
You can make appointments, find out if a provider is in the network, find clinic locations, get answers to billing questions and access other healthcare resources through a dedicated phone number and a single, centralized contact center at 855.520.9500.
Assistance is available seven days a week:
Note that plan coverage starts January 1, 2017. Any appointments prior to that date will not be covered under the UMP Plus – UW Medicine Accountable Care Network option.
A special website for public employees is available at uwmedicine.org/umpplus. It includes comprehensive information on the UMP Plus – UW Medicine Accountable Care Network. You may use the website to:
You can also find information about UMP Plus services at these websites:
|Comprehensive information on the UMP Plus – UW Medicine Accountable Care Network|
|hca.wa.gov/ump||General information about Uniform Medical Plan|
|Regence.com||Medical claims and services as well as search for ancillary providers, such as naturopaths|
|Washington State Prescription Services||Prescription drug information|
You may also call the dedicated phone number for state employees at 1-855-520-9500 to speak to a representative.
For specific questions about plan details and coverage, such as the following, please contact your organization’s personnel, benefits or payroll office:
If you are a provider interested in joining the network, please visit uwmedicine.org/aco/for-providers and fill out the web form to submit your inquiry.