Medical Management Guide, 2009, Version 3.0 - Tricare

More documents

Recommendations

Info

Page 148Appendix A - ReferencesVersion 3.0Medical Management GuideThe Secretary of Veterans Affairs Task Force on Returning Global War on Terror Heroes, 2007. See ExecutiveSummary, CD-ROM Resource ES-7.Title XVI, Section 1611 of the National Defense Authorization Act (NDAA). U.S. House of Representatives, 2008.See Executive Summary, CD-ROM Resource ES-4.Section I – Medical Management EssentialsCousins, Michael S., Shickle, Lisa M., Bander, John A. An Introduction to Predictive Modeling for DiseaseManagement Risk Stratification. Disease Management, September 2002, 5(3): 157-167.Crossing the Quality Chasm: a new health system for the 21st Century. Committee on Quality Health Care inAmerica, Institute of Medicine. National Academy Press, 2001.Despite Barriers, MCOs Integrate Case, Disease, Utilization Management Functions. Managed Care Week.March 2005.DoD Instruction 6025.20, Medical Management (MM) Programs in the Direct Care System (DCS) and RemoteAreas: http://www.dtic.mil/whs/directives/corres/pdf/602520p.pdf.Favor, G., Ricks, R. Preparing to automate the case management process. Nursing Case Management, 1996,1(3), 100-106.First Consulting Group. Access to Care Report for the Air Force Office of the Surgeon General. February 2003.Kelley, M. Model for integrating case management and utilization management. Inside Case Management,2001, 8(8), 8-10.Kongstvedt, P.R. Essentials of Managed Health Care, 5th ed., 378-379. Jones and Bartlett Publishers, 2007.Koulopoulos, T., Champy, J. Building digital value chain. Optimize, 2005, 4(9), 24-34.McKendry, M. J., Sherwin, K. Utilization review and case management integration: An idea whose time hascome…Are you ready? Care Management, 2002, 32-35.Mullahy, C. M. Effective Integration of Utilization and Case Management. The Case Manager, 53-55. 2000.Owen, M. Changes in Case Management. In P. Rossi (Ed.), Case Management in Health Care, 19-32. Saunders,2003.Powell, S.K., Tahan, H.A. CMSA Core Curriculum for Case Management, 2nd ed., 294-300. Lippincott, Williams& Wilkins, 2008.
Medical Management Guide Version 3.0 Appendix A - ReferencesPage 149Qudah, F. J., Brannon, M. Population-Based Case Management. In C. M. Mullahy (Ed.), Essential Readings inCase Management, 2nd ed., 86, 87. Aspen Publishers, 1998.Soumerai, S. B., Avron, J. Principles of education outreach (“academic detailing”) to improve clinical decisionmaking.Journal of American Medical Association, January 1990, 263(4), 549-556.Trends and Practices in Medical Management: 2005 Industry Profile. URAC: http://www.urac.org/docs/resources/MMReport2005.pdf.TRICARE Management Activity (TMA), Population Health Improvement Plan and Guide. TMA/ GovernmentPrinting Office, 2001: http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.TRICARE Fact Sheets, TRICARE Regional Contractors for the United States, Sept. 18, 2006: http://www.tricare.mil/factsheets/viewfactsheet.cfm?id=92.Wilson, W., Carneal, G., Newman, M.B. Documenting Case Management Outcomes, Case in Point, 15. CaseManagement Society of America, February/March 2008: http://www.schoonerhealth.com/files/32736223.pdf.Section II – Utilization ManagementAccreditation Handbook for Ambulatory Health Care. Accreditation Association for Ambulatory Health Care,2008: http://www.aaahc.org/.Carneal, G., Korsch, D. I. (Eds.). The Utilization Management Guide, 3rd ed. URAC, 2005.Code of Federal Regulation (CFR) Title 32, National Defense, Chapter 1: Office of the Secretary of Defense,Section 199, Civilian Health and Medical Program of the Uniformed Services: http://www.gpoaccess.gov/cfr/index.html.• Section 199.2 — Definitions• Section 199.10 — Appeal and hearing procedures• Section 199.15 — Quality and Utilization Review Peer Review Organization (PRO)• Section199.16 — Supplemental Health Care Program for active duty members• Section 199.17 — TRICARE ProgramFreedman, Skip (MD). Understand the nuances of utilization review and utilization management. ManagedHealthcare Executive, Jan. 1, 2006.Kongstvedt, P.R. Essentials of Managed Health Care, 5th ed. Jones and Bartlett Publishers, 2007.McKesson Certified Professional in Healthcare Management (CPHM) Study Guide 2, 2009.TMA Memorandum, Policy Guidance for Referral Management. May 5, 2004; http://www.health.mil/hapolicies.aspx.
Page 2 and 3:
Instructions:When accessing this Gu
Page 6:
Page viExecutive SummaryVersion 3.0
Page 9 and 10:
Medical Management Guide Version 3.
Page 11 and 12:
Page 13 and 14:
Page 15:
Page 20 and 21:
Page Medical Management Essentials
Page 22:
Page Medical Management Essentials
Page 25 and 26:
Medical Management GuideVersion 3.0
Page 27 and 28:
Medical Management GuideVersion 3.0
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39:
Page 44 and 45:
Page 26Utilization Management Versi
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Fig. 11 (cont.) - MTF Review and Ap
Page 68 and 69:
Page 70 and 71:
Page 72:
Page 76 and 77:
Page 58Case Management Version 3.0M
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117: Page 98Case Management Version 3.0M
Page 118 and 119: Page 100Case Management Version 3.0
Page 123 and 124: Medical Management GuideVersion 3.0
Page 165: Medical Management Guide Version 3.
Page 169 and 170: Medical Management Guide Version 3.
show all

Medical Management Guide, 2009, Version 3.0 - Tricare

Create successful ePaper yourself

Delete template?

Save as template?