For Those Who Can’t Do It Alone

TRICARE providers in the West Region can depend on TriWest’s case management department to assist with those beneficiaries who need help managing their health care.

Case management is a program for patients facing complex medical conditions and adverse psychosocial issues that inhibit their abilities to properly manage their own health care needs. Case managers are registered nurses who are available to answer any questions that a beneficiary has about his or her illness and are there to assist the provider with coordinating complex conditions and treatments that a patient might require.

There are times when acute medical or psychological circumstances prevent a beneficiary from properly managing his or her own health. In those instances, case management is there to help you make sure TRICARE beneficiaries’ needs are met both in and out of your office.

Case managers provide many services that will assist you in providing care, such as:

• Case managers provide many services that will assist you in providing care, such as:
• Identifying and facilitating needed services and equipment, in collaboration with the primary care manager, for optimal health care delivery
• Assisting in communication with caregivers on behalf of the beneficiary, providing a point of contact to assist with problem solving, and acting as the beneficiary’s advocate
• Educating the beneficiary on TRICARE benefits and systems
• Identifying community resources
• Educating the beneficiary on his or her disease process and promoting lifestyle changes that can positively affect the management of the disease (e.g., diet, exercise, compliance with the recommended treatment plan, stress management and keeping appointments)

The goal of case management is to help beneficiaries become more independent in the management of their own health care. After a beneficiary has been a program participant for some time, case management will encourage the beneficiary, if medically able, to take on more responsibility for his or her treatment plan.

There are no pre-determined qualifications for case management. Every beneficiary referred to the program is evaluated on a case-by-case basis.

If you encounter a TRICARE beneficiary you believe meets the medical and psychosocial requirements, you may refer the beneficiary to case management. Case management will then review the beneficiary’s situation and determine if he or she is eligible for the program.

the referral form can be found on the TriWest web site.