Important TRICARE Care Coordination Program Change

Effective April 1, 2012, TriWest Healthcare Alliance (TriWest) modified its Care Coordination Program. The program’s goal is to help decrease hospital readmission rates, reduce emergency room utilization, improve patient outcomes, and reduce healthcare costs for the government.

TriWest will contact all hospitals about patients admitted with cardiac and respiratory diagnoses to obtain clinical information regarding the admission and to begin discharge planning. Within two days after discharge, TriWest will also call the beneficiary to determine if the beneficiary understands their discharge instructions, to determine if the beneficiary filled any new prescriptions, and to schedule a follow-up appointment.

The program aims to lower hospital readmission rates by increasing the number of TRICARE beneficiaries who:

• Fill their prescriptions promptly after discharge from the hospital.
• Set up and keep follow-up care appointments with their physicians.

In addition, TriWest will also call hospitals for clinical information when a patient has been readmitted within 30 days of a previous admission and discharge.