Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 106Disease Management Version 3.0Medical Management Guideare at risk for exacerbating or complicating theirdisease.In the Department of Defense (DoD), MTFs havesuccessfully implemented DM programs for anumber of conditions and disease states. Inaccordance with the National Defense AuthorizationAct (NDAA) of 2007, the Military Health System(MHS) was tasked with developing DM programsfor a variety of diseases and chronic conditionsincluding asthma, chronic obstructive pulmonarydisease, diabetes, depression and anxiety disorders,cancer, and heart disease. Thus, MTFs and ManagedCare Support Contractors (MCSCs) have begun tosystematically incorporate these disease states intotheir DM programs.system of coordinated healthcare interventions andcommunications for populations with conditions inwhich patient self-care efforts are significant.”The DMAA has broadened its focus from strictlyDM to a Population Health model, of which DMis a component. This model promotes a proactive,accountable, patient-centric approach featuring a“physician-guided” healthcare delivery approachdesigned to “develop and engage informed andactivated patients over time to address both illnessand long term health” (DMAA, 2009). The MHSPopulation Health model (see Section I, MedicalManagement Essentials, Fig. 3) is based on ahealthcare delivery approach that incorporates sixkey components illustrating this paradigm from aprovider-guided approach.Definition, Goals, and PurposeDM is an organized effort aimed at achievingdesired health outcomes in populations withprevalent, often chronic, diseases for whichhealthcare delivery may be subject to considerablevariation (Kongstvedt, 2007) (see also Appendix C,Definitions). In contrast to CM’s focus on individualpatients, DM is aimed at sub-populations of patientswith a specific condition, disease, or set of comorbidities(e.g., the metabolic syndrome associatedwith diabetes, hypertension, and hyperlipidemia).The principles of DM are applicable to all venuesof healthcare delivery, including the inpatient andoutpatient settings in both the primary and specialtycare arenas.According to the Disease Management Associationof America (DMAA, 2009): The Care ContinuumAlliance (hereafter referred to as DMAA), DM is “aDM program goals are to improve clinical outcomes,increase patient and provider satisfaction, andpromote appropriate utilization of resourcesthroughout the MHS. The purpose of DM isto improve the quality of life for individuals bypreventing or minimizing the impact of a disease orchronic condition. This purpose is accomplished byactivities such as implementing more standardizedcare and improving patients’ ability to care forthemselves.Per the DMAA (2009), a DM program:• Emphasizes prevention of exacerbations andcomplications by using evidence-based practiceguidelines and patient empowerment strategies.• Supports the healthcare provider/patient relationshipand plan of care.• Evaluates clinical, humanistic, and economicoutcomes on an ongoing basis with the goal ofimproving overall health.
Medical Management GuideVersion 3.0Disease ManagementPage 107The Current State of DiseaseManagementProviders have long strived to return patients tooptimum health. It has only been since the mid-1990s that DM became the program of choice formanaging patient populations (Sprague, 2003).Several driving forces (e.g., congressional mandates,TMA policy, increasing costs) have influenced theMHS’ move to adopt more robust DM practices.There is strong evidence for efficacy of health promotion,disease prevention, and condition managementprograms in both the MHS and the civilianhealthcare arena.Effective DM is a cost-effective approachto enhancing quality of life, postponing thedevelopment of complications, and consistentlyimproving health outcomes for all beneficiarypopulations in the MHS. DM should no longer beviewed as a burden to healthcare teams but ratheras an effective means for improving the futurehealth of defined populations.Managing Chronic Disease in the MilitaryHealth SystemIn the MHS, the incidence of chronic disease inActive Duty Service members (ADSMs) is approximately21 percent (Armed Forces Health SurveillanceCenter, 2009). However, the vast majority of chronicillnesses in the MHS are present in the retiree andfamily member population. Approximately 30percent of military members remain in the Serviceuntil retirement and become lifetime beneficiaries(Force Readiness and Manpower InformationSystem, 2003). Therefore, the long-term carecoordination and resulting program benefits for thispopulation can be maximally realized in the MHS byleveraging MM resources.In 2005, 133 million people — almost half ofall Americans — lived with at least one chroniccondition (e.g., heart disease, cancer, diabetes).These diseases cause major limitations in dailyliving for almost 1 in 10 Americans (Agency forHealthcare Research and Quality [AHRQ], 2009). Infact, chronic diseases account for 70 percent of alldeaths in the U.S., or about 1.7 million each year(National Center for Chronic Disease Prevention andHealth Promotion [NCCDPHP], 2008). These diseaseshave a severe impact on quality of life, resulting insignificant increases in individual healthcare costsand the development of conditions that lead to ahigh rate of morbidity.Supporting the link between clinical and businessoperations and evidence-based health care (e.g.,asthma, diabetes, and cancer screening) is includedas one of eight critical initiatives in Tri-Servicebusiness planning (described in Section I, MedicalManagement Essentials). In accordance with theNDAA of 2007, the MHS placed a greater emphasison integrating DM programs for a variety of diseasesand chronic conditions with enterprise activities.Consequently, the incorporation of evidence-basedmedicine practices and programs has assumeda higher priority in the administration of currentTRICARE contracts. (For more on the link betweenclinical and business operations, see Section I,Medical Management Essentials. For moreinformation on Tri-Service business planning, seeSection V, Medical Management Tools.)To support the objectives of their business plans,
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