Medical Management Guide, 2009, Version 3.0 - Tricare

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Page xiiVersion 3.0Medical Management GuideRecovery Coordination Initiatives............................................................................................................................. 87Federal Recovery Coordination Program............................................................................................................ 87Recovery Care Coordinators....................................................................................................................... 87Transition/Coordination of Care............................................................................................................................... 88Transition of Care............................................................................................................................................. 88Service-Specific Care Transition Programs................................................................................................... 89Inter/Intra-Regional Transfer....................................................................................................................... 89Aeromedical Evacuation............................................................................................................................. 90Coordination of Care........................................................................................................................................ 92Coordination from the Military Health System to the Department of Veterans Affairs................................. 92Coordination for Active Duty Service Members in the TRICARE Prime Remote Program.............................. 92Coordination for Exceptional Family Member Program and Special Needs Families...................................... 93Transition/Coordination Challenges................................................................................................................... 95Other Types of Transition/Coordination............................................................................................................. 95Outside the Continental United States and TRICARE Global Remote Overseas Program.............................. 96The Case Management Professional........................................................................................................................ 97Qualifications................................................................................................................................................... 97Education and Experience Requirements.................................................................................................... 97Certification............................................................................................................................................... 98Ethical Practice Standards........................................................................................................................... 98Resources for Orienting and Training the New Case Manager........................................................................... 99Summary................................................................................................................................................................ 100CD-ROM Resources................................................................................................................................................. 100Section IV – Disease Management.......................................................................................................... 105Introduction............................................................................................................................................................ 105Definition, Goals, and Purpose.......................................................................................................................... 106The Current State of Disease Management....................................................................................................... 107Managing Chronic Disease in the Military Health System............................................................................ 107Employer-Funded Health Plans................................................................................................................... 108Cost Savings for Disease Management....................................................................................................... 108Disease Management Components........................................................................................................................ 109Population Identification Processes................................................................................................................... 109Evidence-Based Clinical Practice Guidelines....................................................................................................... 110Fundamentals............................................................................................................................................ 110Department of Defense/Department of Veterans Affairs Clinical Practice Guidelines................................... 112National Guideline Clearinghouse........................................................................................................... 114
Medical Management Guide Version 3.0Page xiiiU.S. Preventive Services Task Force............................................................................................................. 114Collaborative Practice Models........................................................................................................................... 115Patient Self-Management Education................................................................................................................. 116Process and Outcome Measurement, Evaluation, and Management.................................................................. 118Clinical Quality Measures........................................................................................................................... 119Feedback and Reporting................................................................................................................................... 123Stakeholder Reporting................................................................................................................................ 123Establishing a Disease Management Program....................................................................................................... 124Implementing a Disease Management Plan....................................................................................................... 124Assess the Target Population...................................................................................................................... 125Assemble a Team....................................................................................................................................... 125Adopt Guidelines and Protocols................................................................................................................. 126Establish Goals and Target Outcomes......................................................................................................... 126Create a Prioritized Plan and Implement the Plan........................................................................................ 127Collect and Analyze Outcomes Data........................................................................................................... 127Evaluate and Refine the Program................................................................................................................ 127Accreditation............................................................................................................................................. 127The Disease Management Professional................................................................................................................. 128Qualifications................................................................................................................................................... 128Certification..................................................................................................................................................... 129Summary............................................................................................................................................................. 129CD-ROM Resources.............................................................................................................................................. 130Section V – Medical Management Tools............................................................................................ 133Introduction......................................................................................................................................................... 133Using Information Systems and Data Marts ......................................................................................................... 133Accessing the Data........................................................................................................................................... 133Understanding the Methodology and Limitations............................................................................................. 134Data Quality Concerns...................................................................................................................................... 134Information Systems And Data Marts ................................................................................................................ 134Military Health System-Level Decision Support Tools and Executive Information Systems................................ 134Armed Forces Health Longitudinal Technology Application............................................................................... 134Executive Information and Decision Support..................................................................................................... 134Tools for Utilization, Case, and Disease Management Collaboration...................................................................... 135TRICARE Management Activity Reporting Tools .............................................................................................. 136Health Assessment Review Tool........................................................................................................................ 139MHS Insight...................................................................................................................................................... 140
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Medical Management Guide, 2009, Version 3.0 - Tricare

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