triwest

By Debbie Gregory.

The Department of Veteran Affairs (VA) has awarded TriWest Healthcare Alliance a five year, $4.3 billion contract for the provider to administer the VA Patient-Centered Community Care (VAPCCC) program to nearly half of the Veterans eligible for care in the country. The 3, 5 & 6 regions covered by TriWest include all or portions of 28 states, including: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Tennessee, Texas, Virginia, Washington and West Virginia, as well as American Samoa, Guam and the Northern Mariana Islands.

The new contract has the potential to improve access to health care services for Veterans by making a quality provider network available close to the Veteran’s home. This contract was designed to ensure that Veterans receive coordinated, high quality care in their community when VA refers behavioral health and specialty care to the network.

Under the new contract, TriWest will provide access to high quality health care services through their network of providers, as well as referral management, patient appointing, medical documentation tracking, coordination of admissions and discharges in community facilities, clinical quality management and claims payment.

The TriWest Healthcare Alliance was founded in 1996 by 16 non-profit health plans and two university hospital systems. Designed to provide service members and their families, as well as Veterans and their families with access to high quality health care and customer service, TriWest’s aim is customer service. According to their website, TriWest’s motto is to do “whatever it takes!” for their customers.

TriWest’s contract is part of a new Patient Centered Community Care (PC3) initiative, which the Department of Veterans Affairs intends to implement across the country over the next six months.

The initiative is centered on two five-year contracts, worth a combined $9.3 billion, awarded to TriWest and Health Net Federal Services LLC. Health Net is the current TRICARE support contractor for military beneficiaries in  Regions 1, 2 & 4, which span the New England states, the Northern Midwest states and all Eastern seaboard states down through Florida and Alabama.

Under the PC3 initiative, TriWest and Health Net will provide inpatient and outpatient specialty care, and mental health care services when local VA medical centers cannot, either due to availability of resources or location of the patient.

Under a previous directive, when VA facilities lacked the capacity to provide care in-house, patients were referred to private sector care, which were under different local contracts, share agreements and medical care authorizations. The VA viewed the lack of consistency inefficient. Future referrals will be consolidated under PC3 contracts so veterans see more coordinated and timely access to comprehensive networks of providers, all of them screened to meet uniform VA quality standards.

The new networks will be required to screen providers to ensure that they meet or exceed VA standards for credentialing, licensing and specialty care requirements. They will need to establish customer service and complaint procedures, and will be required to examine patients within a specified period while being geographically convenient. Also, medical files generated by network specialists will be shared with the VA in order to ensure that all VA care is closely monitored and coordinated.

The PC3 networks are expected to be operating across the country by April, 2014.