Effectiveness of Care for TRICARE Beneficiaries

TriWest Healthcare Alliance utilizes the Healthcare Effectiveness Data and Information Set (HEDIS) measures to evaluate performance on the effectiveness of important dimensions of care and service. HEDIS is a tool used by more than 90 percent of America’s health plans to make improvements in their quality of care or service.

Using HEDIS measures, TriWest monitors effectiveness of care specific to TRICARE beneficiaries for important health issues. For 2009, the Department of Defense (DoD) provided TriWest with the following three metrics of focus:

• Breast Cancer Screening
  • Measure: Percent of women between 42-64 years of age who had at least one mammogram in the past two years without a documented mastectomy.
• Cervical Cancer Screening
  • Measure: Percent of women between 18-64 years of age who had at least one Pap smear in the past two years without a documented hysterectomy.
• Colorectal Cancer Screening
  • Measure: Percent of men and women between 50-64 years of age who had a colorectal screening in the past two years; patients with a diagnosis of colorectal cancer or with a previous total colectomy are excluded.

Your assistance in ensuring that your patients who are TRICARE beneficiaries receive appropriate clinical preventive services is greatly appreciated.

Published Date: 08/03/2009