Medical management programs

The following medical management programs apply to UMP members. Note: HTCC decisions will be incorporated, as appropriate.

Sleep Medicine: Services subject to the program's pre-authorization requirements

Physical Medicine:

  • Most services are subject to the program's pre-authorization requirements
  • Pain management, spine and joint services subject to the program's pre-authorization requirements
  • Neurodevelopmental, occupational, physical and speech therapy (NDT/OT/PT/ST) visits are subject to the program's pre-authorization requirement. Pre-authorization is required for more than 18 visits per injury or episode of care for neurodevelopmental, occupational, physical or speech therapies.

Radiology: Services subject to the Advanced Imaging Authorization program's pre-authorization requirements

Learn more about these programs.

Care management programs

UMP offers several programs to help members improve their health, including knee and hip replacement, spine care, diabetes prevention and management, tobacco cessation, maternity support and expert second opinions.

Learn about these programs for PEBB and SEBB members.

Mental health services from Quartet, a mental health technology company, will be available at no charge to UMP members in Washington state. Quartet facilitates access and promotes an integrated approach to care by connecting members, primary care physicians and behavioral health providers to their web-based care coordination platform. Quartet’s SmartMatch algorithm and Care Navigation team match members to in-person and telehemedicine outpatient mental health providers who are in-network, have availability and offer an array of mental health services, including but not limited to: therapy, psychiatric care, outpatient substance use disorder services and severe mental illness treatment.

Learn more at quartethealth.com.

Diabetes program
UMP members ages 18 to 64 with risk factors for prediabetes have access to Omada, an online program.

The program combines proven science with personalized support to help participants build healthy habits that last—whether that means improving eating habits, activity levels, sleep or stress management. The program includes:

  • A professional health coach for one-on-one guidance to help keep participants on track.
  • A wireless scale to monitor progress. Participants will receive a ready-to-use device in the mail, already synced to their private account.
  • Weekly online lessons to educate and inspire. Participants are guided through online lessons that tackle physical, social and psychological components of healthy living. Interactive games reinforce learning and help participants make connections to real-world scenarios.
  • A small peer group for real-time support. Participants are matched with like-minded participants for added encouragement and accountability.

Members will complete an online screening to determine eligibility based on their BMI and a risk factor of prediabetes. The program is offered at no cost to eligible members.

More information about the program is available on Omada's website.

Healthwise decision-making tools
We are pleased to join other top health plans, health systems and hospitals, care management companies, and consumer health portals by making Healthwise’s Knowledgebase available to all Regence providers, as well as to UMP members. The knowledgebase includes:

  • Evidence-based, easy-to-understand health education
  • Innovative technology solutions that integrate with complex health IT systems
  • Expert guidance on game-changing approaches, such as behavior change and shared decision-making

Healthwise provides content and technology to help people make better care decisions and manage their health, including information about health topics, videos and tools on hundreds of specific conditions, prevention, life stages and more. We encourage you to use and share this source of information with your patients so they can learn about their health condition(s).

Healthwise has been in business for 40 years and has the following achievements:

  • URAC Certificate of Full Accreditation, 2020-2022
  • NCQA Certification, 2018-2020—Healthwise Self-Management Tools

Learn more.

Other programs and initiatives

If you’re not already, we encourage you to learn about and participate in the following community initiatives:

  • Washington Health Alliance
    The Washington Health Alliance (WHA) is a health system improvement nonprofit organization in Washington. Located in Seattle, the WHA brings together health care stakeholders to create a high-quality, affordable system for the people of Washington state. The WHA also produces and shares the most reliable data on Health Care Quality and value in the state to help providers, patients, employers and union trusts make better decisions about health care.
  • Bree Collaborative
    The Bree Collaborative is a multi-stakeholder, Governor-appointed group working to improve the quality, health outcomes and cost effectiveness of care in Washington. The Bree Collaborative produces best practice recommendations for health care services that experience a high variation of care delivery, are frequently used but do not lead to better care or patient health, or that experience patient safety issues
  • Accountable Communities of Health
    Accountable Communities of Health (ACHs) are regional health collaboratives that bring together leaders from multiple health sectors with a common interest in improving health and health equity throughout the state. As ACHs align resources and activities that improve whole person health and wellness. Nine ACHs serve the entirety of Washington State, the boundaries of which align with Medicaid Regional Service Areas.

We support the goals of the ACH and the relationship of the Medicaid transformation work with the health care delivery systems in our commercial provider networks.

  • Hutchinson Institute for Cancer Outcomes Research
    Hutchinson Institute for Cancer Outcomes Research (HICOR) is a research institute at Fred Hutchinson Cancer Research Center whose mission is to improve cancer prevention, detection and treatment in ways that will reduce the economic and human burden of cancer. HICOR brings together patient organizations, clinicians, industry leaders, insurers and policy developers to share cancer-related data and generate performance metrics that are clinically relevant and can guide improvements in cancer care.
  • National Business on Health e-Value8 Initiative
    e-Value8 is a transformational resource that helps purchasers and employers measure and evaluate health plan performance. The WHA sponsors a biannual e-Value8 which is supported by the HCA.
  • Practice Transformation Support Hub
    The Practice Transformation Support Hub is a key initiative to support clinical practices to incorporate evidence-based guidelines and Patient-Centered Medical Home PCMH concepts into care delivery.

We encourage you to use Certified Health Information Technology and participate in Washington State’s Clinical Data Repository and Health Information Exchange.