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.

1) What is an Accountable Care Network?

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.

2) Why is the state offering this option?

The UMP Plus network options focus on making healthcare more affordable and keeping people well with preventive medicine and better coordinated care–so members 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.

3) Who is eligible for the UMP Plus - UW Medicine Accountable Care Network?

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:

  • Employees
  • Leave Without Pay members
  • Retirees and their covered spouses or registered domestic partners not enrolled in Medicare Part A and Part B
  • COBRA members and their covered spouses or registered domestic partners not enrolled in Medicare Part A and Part B.

4) What organizations are included in the UMP Plus - UW Medicine Accountable Care Network?

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:

  • Capital Medical Center
    • Capital Physician Services
  • Capital Physician Services
  • Children’s University Medical Group
  • MultiCare ConnectedCare
    • MultiCare Allenmore Hospital
    • MultiCare Auburn Medical Center
    • MultiCare Good Samaritan Hospital
    • MultiCare Mary Bridge Children’s Hospital and clinics
    • MultiCare Tacoma General Hospital
    • MultiCare Clinics
    • Grays Harbor Community Hospital
  • Overlake Hospital Medical Center
  • Overlake Medical Clinics
  • Seattle Cancer Care Alliance
  • Seattle Children’s Hospital
  • Skagit Regional Health
    • Skagit Valley Hospital
    • Skagit Regional Clinics
    • Cascade Valley Hospital and Clinics
  • UW Medicine
    • Harborview Medical Center and clinics
    • Northwest Hospital & Medical Center and Clinics
    • UW Medical Center and clinics
    • UW Neighborhood Clinics
    • UW Physicians
    • Valley Medical Center and Clinics
    • Airlift Northwest

5) How much does the UMP Plus – UW Medicine Accountable Care Network cost?

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.

6) How is the UMP Plus - UW Medicine Accountable Care Network different from the care I’m already receiving at one of the network organizations?

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, you will have access to the following services and benefits:

  • The most comprehensive healthcare network in the Puget Sound region
  • Lower monthly premiums, giving you high-quality care that is more affordable
  • A single, centralized contact center for all services – one call does it all
  • Fast scheduling for appointments
  • Access to the UW Medicine ACN Virtual Clinic at no extra charge
  • A coordinated care team – including easy referrals to specialists
  • A 24-hour nurse care line for immediate, professional advice on health questions

7) What does it mean when it says the UMP Plus - UW Medicine Accountable Care Network offers “the most comprehensive healthcare network in the Puget Sound region?”

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:

  • More than 1,100 primary care providers
  • More than 5,800 specialists
  • More than 1,250 clinics,
  • 15 hospitals, including the number 1 ranked hospital in Washington State by S. News & World Report
  • 33 urgent care clinics
  • 17 emergency departments

Additional benefits include:

  • A single access point for all appointments and information
  • Emphasis on primary and preventive care to keep you healthy
  • An industry-leading outpatient program to manage care for chronically ill patients
  • 24/7 access to a registered nurse care line
  • A free virtual care clinic to provide 24/7 care for minor medical problems in the comfort of your own home
  • Online access to your electronic health records so you can have view test results as they become available

And if you should need specialty services, our teams provide the following:

  • The only Level 1 adult and pediatric trauma and burn center in the region, and 11 other trauma centers
  • Two Level 1 stroke centers
  • Six Level 1 cardiac care centers
  • Extensive network of pediatric services and western Washington’s only two dedicated children’s hospitals
  • Extensive network of maternity services and four neonatal intensive care units
  • The region’s only proton therapy center
  • The only network that provides all organ and bone marrow transplants
  • Solid organ transplantation (liver, kidney, lung, heart, pancreas, intestinal)
  • The region’s leading cancer care and research organization
  • A 24/7 virtual clinic that provides treatment at no charge through a webcam or over the phone from board-certified doctors and nurse practitioners

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.

8) What pediatric care is offered through the UMP Plus - UW Medicine Accountable Care Network?

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.

9) What type of cancer care is offered through the UMP Plus - UW Medicine Accountable Care Network?

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.

10) What is the UW Medicine ACN Virtual Clinic?

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.

11) If I choose the UMP Plus - UW Medicine Accountable Care Network, do I have to choose a primary care provider?

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.

12) In the UMP Plus - UW Medicine Accountable Care Network, do I need a referral to see a specialist?

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.

13) Can I see a healthcare professional outside the UMP Plus - UW Medicine Accountable Care Network?

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.

14) Can different family members go to different physician and different hospitals or clinics as long as they’re in the same network?

Yes. You and your family members may use different facilities and providers within the UMP Plus – UW Medicine Accountable Care Network 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.

15) How do I know if my provider is in the UMP Plus – UW Medicine Accountable Care Network?

You may search a database of network providers, clinics and hospitals by visiting uwmedicine.org/umpplus. You may also search a database of primary, specialty and ancillary providers at regence.com. Or simply call the dedicated contact center at 1-855.520.9500.

16) What is an ancillary provider or service?

Ancillary providers are certain types of providers who may be within your UMP Plus–UW Medicine Accountable Care Network because they are a Regence network provider.

Following are examples of ancillary providers:

  • Chiropractors
  • Laboratories (lab testing)
  • Physical therapists
  • Registered dieticians
  • Anesthesiologists
  • Dialysis

A full list of ancillary services and providers is available at regence.com.

17) How do I know if an ancillary provider is in the UMP-Plus Plan network?

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 in-network benefits for UW Medicine ACN affiliated providers as well as providers contracted with Regence.

18) If I already see a doctor at a UMP Plus - UW Medicine Accountable Care Network location, will I still have access to my medical records if I switch to the Accountable Care Network option?

Yes, you will have the same access to your medical records as you do today.

19) If I switch to the UMP Plus – UW Medicine Accountable Care Network from outside the network, do I have to transfer my medical records or will that be done for me?

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.

20) How do you safeguard the privacy of my medical records?

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.

21) Can I only sign up for the UMP Plus - UW Medicine Accountable Care Network during open enrollment?

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.

22) When does my coverage start?

Coverage under plans chosen during the open enrollment period (November 1 – 30, 2017) begins January 1, 2018.

23) Where do I call to make an appointment?

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:

  • 6:30 a.m. to 8:00 p.m., Monday through Friday
  • 7:00 a.m. to 8:00 p.m. on Saturdays
  • 8:00 a.m. to 5:00 p.m. on Sundays

Note that plan coverage starts January 1, 2018. Any appointments prior to that date will not be covered under the UMP Plus – UW Medicine Accountable Care Network option.

24) Where do I get more information about the UMP Plus - UW Medicine Accountable Care Network?

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:

  • See whether your current physician or healthcare professional is covered under the UMP Plus – UW Medicine Accountable Care Network
  • See whether your hospital or clinic is part of the UMP Plus – UW Medicine Accountable Care Network
  • Search a database of healthcare providers, clinics and facilities
  • Find dates and times of upcoming informational webinars explaining UMP Plus – UW Medicine Accountable Care Network benefits

You can also find information about UMP Plus services at these websites:

Website Information
uwmedicine.org/umpplus

 

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:

  • Cost savings
  • Rules about pre-existing conditions
  • Seeing out-of-network physician and healthcare professionals
  • Services not covered under the plan
  • Prescription coverage/transfers
  • Family/dependent coverage
  • Dental and vision coverage
  • Coverage for naturopathic medicine and other alternative health healthcare professionals
  • Differences between current Uniform Medical Plans and the UMP Plus – UW Medicine Accountable Care Network option
  • Differences between UMP Plus – UW Medicine Accountable Care Network and other ACP option

25) I’m a provider looking to join the UMP Plus – UW Medicine Accountable Care Network. How do I make this request?

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.