Condition Management Program
Available to TRICARE Beneficiaries

TriWest Healthcare Alliance Corp. offers a beneficiary-focused Condition Management Program designed to help TRICARE West Region beneficiaries with specific conditions take a more active role in their own health care. Previously known as the Disease Management program, Condition Management focuses on educating patients on how to improve their health management skills while living with a chronic illness.

Available at no charge to TRICARE beneficiaries and their family members, Condition Management is a prospective, disease-specific approach to improving health care outcomes by providing one-to-one education to beneficiaries through a "clinical health coach" specially trained in the targeted diseases. The goal of these programs is to provide beneficiaries with self-management skills to manage their health conditions, as well as skills to improve their quality of life.

TRICARE-eligible beneficiaries suffering from the following four conditions can benefit from participating in the disease management program:

• Asthma (adults and children)
• Heart failure
• Diabetes (adults and children)
• Depression

TriWest encourages providers to refer beneficiaries with the identified targeted conditions to our Condition Management Program. TRICARE beneficiaries can also self-refer into the program. In addition, TRICARE Management Activity (TMA) periodically sends TriWest a list of beneficiaries that they have identified who may benefit from our asthma, diabetes, and heart failure programs based on the following:

• Number of inpatient admissions
• Number of outpatient visits
• Number of emergency room visits
• Number of prescription (Rx) medications
• Number of inpatient admissions for disease
• Number of outpatient admissions for disease
• Number of emergency room admissions

Condition Management differs from TriWest’s Case Management program. Case Management interacts with TRICARE beneficiaries who are dealing with high risk medical conditions, such as lung transplants, cancer clinical trials, and high risk psychological risk factors (suicidal, bi-polar, etc.). Condition Management typically works with beneficiaries with less acute conditions.

TriWest automatically enrolls all identified beneficiaries into the program until they opt out. Once a beneficiary is enrolled in the Condition Management program, a TriWest clinical health coach will:

• Schedule an appointment to call and review the patient’s health status
• Develop a customized educational plan based on the patient’s status and personal health goals
• Inform the patient’s physician of the patient’s program participation
• Work with the patient to reach established goals
• Continue to help the patient as long as he/she wants to participate and work toward achieving wellness goals

Any patient coping with asthma, depression, diabetes or heart failure who is eligible for TRICARE and is less than 65 years old is eligible for referral. Our programs average 6-to-9 months in duration depending on the amount of support and education the beneficiary may need.

To refer a TRICARE beneficiary to the program, go to www.triwest.com and the "Find a Form" tab for a Condition Management Referral form. You may also contact TriWest’s Condition Management staff at 1-888-259-9378 or by fax at 1-866-312-5839.

For more information about Condition Management, refer to the Condition Management Program section in the Healthy Living area of www.triwest.com.