An Overview of TriWest’s Disease Management Program
TriWest Healthcare Alliance offers a beneficiary-focused Disease Management program designed to help TRICARE West Region beneficiaries with specific conditions take a more active role in their own health care
TriWest’s Disease Management program is a prospective, disease-specific approach to improving health care outcomes by providing education to beneficiaries in the TRICARE West Region through clinicians who are specially trained in the targeted diseases. Other program highlights include:
- Beneficiaries are identified by the TRICARE Management Activity (TMA) through monthly data sharing and are automatically enrolled into the program.
- The program is an opt-out program. Beneficiaries are contacted by mail and by telephone until they decline to participate.
- Education is provided by registered nurses and a dietician who serve as part of TriWest’s Disease Management staff.
Who Benefits from Disease Management?
TRICARE-eligible beneficiaries suffering from Asthma or from Congestive Heart Failurecan benefit from participating in the disease management program. The minimum criteria for enrollment are one or more emergency room visits or one or more inpatient admissions with either of these primary diagnoses.
How Are Participating Beneficiaries Educated?
Beneficiaries actively participating in the program may receive disease-specific educational materials and information in the privacy of their own home by:
- Telephone
- Internet
When Can a Beneficiary be Referred to the Program?
In addition to automatic enrollment of beneficiaries by TMA, TriWest encourages providers to refer beneficiaries with the identified targeted conditions to our Disease Management program at any time. The sooner the beneficiary can become involved in the program, the sooner he or she can begin to benefit from its educational and support-related features.
When beneficiaries complete an initial health survey, the primary care manager (PCM) will receive a letter letting them know the beneficiary is an active participant.
The Disease Management Notification Form, which is used for the referrals of beneficiaries to the TriWest Disease Management program, can be found at www.triwest.com>Provider Connection>Find a Form>Provider Forms.
There also are several educational documents utilized by TriWest staff when they interact with the beneficiaries. These documents are reviewed at least every six months for accuracy and relevancy by TriWest senior medical leadership. Providers can review the educational materials on the Healthy Living portal located on www.triwest.com.
For more information, or to refer a TRICARE beneficiary to the program, please contact TriWest’s Disease Management staff at 1-888-259-9378 or by fax at 1-866-312-5839.