Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 138Medical Management Tools Version 3.0Medical Management Guideand ambulatory encounters, reportable events, anddemographic data elements.5. TRICARE Operations Center: http://mytoc.tma.osd.mil/4. Medical Expense & Performance ReportingSystem Early Warning and Control System: http://www.meprs.info/mol3The Medical Expense & Performance ReportingSystem (MEPRS) Early Warning and Control System(MEWACS) is a robust, interactive, user-friendly dataquality surveillance tool developed by the MEPRSManagement Improvement Group (MMIG) toproactively identify, investigate, resolve, or correctMEPRS data anomalies in a timely manner usingsystematic, repeatable processes. It is a valuable MMtool for monitoring resource consumption and clinicproductivity. MEWACS provides detailed informationat the MTF level and does not require a passwordfor access.MEWACS currently contains up to 24 months ofTri-Service MTF activity-level measures, including:• EAS IV Repository data status and compliancewith 45-day reporting suspense.• Interactive MTF MEPRS data profiles bythird-level functional cost code.• MTF-specific summary data outliers and varianceassessments.• A WWR vs. EAS IV Repository total ambulatoryvisit comparison.• Ancillary and support expense allocation tests.MEWACS is updated monthly and is available fordownload at the end of each month.This tool is an MHS healthcare information Webportal providing decision-makers at all levels ofthe organization with meaningful, easy-to-use,Web-based operational tools and reports. TheCenter provides useful MM resources, such as atemplate analysis tool, inpatient daily summaries,length-of-stay (LOS) analysis, provider schedules,and appointment cancellations by MTFs. Generalaccess is available through the TRICARE website;direct access to the tool requires a username andpassword.6. Patient Administration Systems and BiostatisticsActivity: *Restricted accessThe Patient Administration Systems and BiostatisticsActivity (PASBA) offers a wealth of valuableinformation for preparing MM plans. The Armyuses PASBA to post utilization reports for the MHSthat are stratified by Service, fiscal year, currentprocedural terminology (CPT) code, diagnosis-relatedgroup (DRG), and International Classification ofDiseases-Ninth Edition-Clinical Module (ICD-9-CM)codes. (See also Appendix C, Definitions.)The following is a list of available reports:• Top 100 CPT for Non-Same Day Surgery• Top 100 CPT for Same Day Surgery Report• Top 100 DRG by Case Weighted Product• Top 100 DRG by Frequency• Top 100 ICD-9-CM for Non-Same Day Surgery• Top 100 ICD-9-CM for Same Day Surgery• Top 25 CPT for Non-Same Day Surgery forActive Duty
Medical Management GuideVersion 3.0Medical Management ToolsPage 139• Top 25 CPT for Same Day Surgery for ActiveDuty• Top 25 DRG by Case Weighted Product forActive Duty• Top 25 DRG by Frequency for Active Duty• Top 25 ICD-9-CM for Non-Same Day Surgeryfor Active Duty• Top 25 ICD-9-CM for Same Day Surgery forActive DutyThese reports are available for all DoD and VAregional commands and medical facilities. Data areposted once a year, usually in January or February,for the previous fiscal year.7. Military Health System Population Health Portal:*Restricted access• Chlamydia screening• High cardiovascular risk• Lipid riskBy generating provider-level action lists of patients,the Portal enables risk stratification and targetingof provision of services to the enrolled population.The ability of the Portal to identify individuals whoare considered “high utilizers” directly supports MMactivities and encourages collaboration betweenUM, CM, and DM.The Portal also assists in the evaluation of the MMprogram by providing:• Aggregate measures (e.g., HEDIS ® ) to assess theperformance of a branch clinic or MTF.• Action lists to enable other critical analyses atthe patient, provider, clinic, or MTF level.The Military Health System Population Health Portal(MHSPHP) allows MM professionals to identifyand assess their populations, forecast and managedemand, and provide evidence-based care toindividuals needing clinical preventive services andDM. Although the tool has a common log-in page,each Service has a unique name and home pagefor its application — the Army Population HealthInformation Connection, the Navy Population HealthNavigator, and the Air Force Population HealthPortal.This tool provides patient demographic informationand identifies patients requiring clinical preventiveservices, including but not limited to:• Cancer screeningo Breast cancero Cervical cancero Colon cancerHealth Assessment Review Tool — formerlyHealth Enrollment Assessment ReviewThe Health Assessment Review Tool (HART),formerly known as the Health EnrollmentAssessment Review (HEAR), is a DoD automatedhealth assessment tool. Information from the HARTcan be used to help establish prevalence of healthrisk behaviors and to set MM priorities accordingly.CD-ROM Resource MMT-2 describes variousaspects of the tool, and CD-ROM ResourceMMT-3 records the change from HEAR to HART perthe Assistant Secretary of Defense for Health Affairs(ASD [HA]) in 2005.
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