Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 152Appendix A - ReferencesVersion 3.0Medical Management GuideEmployer Health Benefits: 2006 Summary of Findings, 6. Kaiser Family Foundation and Health Research andEducational Trust, 2006: http://www.kff.org/insurance/7527/upload/7528.pdf.Healthcare Effectiveness Data and Information Set (HEDIS ® ): http://www.ncqa.org/tabid/59/Default.aspx.Innovations in Chronic Care: A New Generation of Initiatives to Improve America’s Health, ix-x. America’s HealthInsurance Plans, March 2007: http://www.ahipresearch.org/PDFs/Innovations_InCC_07.pdf.Kongstvedt, P. R. Essentials of Managed Health Care, 5th ed. Aspen, 2007.MHS Clinical Quality Management: https://www.mhs-cqm.info/Open/Files/2006_Report_to_Congress.pdf.Most American Adults Have at Least One Chronic Medical Condition. AHRQ News and Numbers, Agency forHealthcare Research and Quality. March 28, 2008: http://www.ahrq.gov/news/nn/nn052808.htm.National Committee for Quality Assurance (NCQA): http://www.ncqa.org.Military Health System Clinical Quality Management (CQM): https://www.mhs-cqm.info/index.aspx.Nichols, W., Farley, D. O., Vaiana, M. E., Cretin, S. Putting Practice Guidelines to Work in the Department ofDefense Medical System: A Guide for Action. Rand, 2001.Overview: National Center for Chronic Disease Prevention and Health Promotion, 2009: http://www.cdc.gov/nccdphp/overview.htm.Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and HealthPromotion, revised August 2008:• Preventing Heart Disease and Stroke. http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/dhdsp.htm.• Preventing Diabetes and Its Complications: http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/diabetes.htm.Sprague, L. Disease management to population-based health: Steps in the right direction. National Health PolicyForum, 2003, 791(3).The Joint Commission (TJC): http://www.jointcommission.org.Welch W. P., Bergsten, C., Cutler, C., Bocchino, C., Smith, Richard I. Disease management practices of healthplans. American Journal of Managed Care, (8) 353-361, 2002.Section V – Medical Management ToolsDefense Health Program (DHP) Performance Contract, TOPS Feature Fourth Quarter FY 2000: http://www.tricare.mil/reptcard/tops/topsrept0012.htm.
Medical Management Guide Version 3.0 Appendix A - ReferencesPage 153GENERAL REFERENCESExecutive SummaryAccreditation Handbook for Ambulatory Health Care. Accreditation Association for Ambulatory Health Care,2008: http://www.aaahc.org/eweb/StartPage.aspx.32 CFR 199.17, TRICARE Program: http://www.access.gpo.gov/nara/cfr/waisidx_05/32cfr199_05.html.42 CFR, Public Health, Centers for Medicare and Medicaid Services (CMS) — Information updated as of July 16,2009: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title42/42tab_02.tpl.Section I – Medical Management EssentialsDoD Population Health Improvement Plan and Guide, 2001. TMA/Government Printing Office:http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.DoDD 1010.10, Health Promotion and Disease/Injury Prevention, Aug. 22, 2003:http://www.dtic.mil/whs/directives.DoDD 6025.18-R, DoD Health Information Privacy Regulation, January 2003:http://www.dtic.mil/whs/directives.Dranove, D. The Economic Evolution of American Healthcare: From Marcus Welby to Managed Care. PrincetonUniversity Press, 2002.Kongstvedt, P. R. Managed Care: What It Is and How It Works, 2nd ed. Jones and Bartlett, 2007.Privacy Act of 1974 (as amended): http://www.usdoj.gov/opcl/privstat.htm (U.S. Department of Justice).Health Insurance Privacy and Accountability Act of 1996 (HIPAA), Aug. 21, 1996:http://aspe.hhs.gov/admnsimp/pL104191.htm. See also:• Centers for Medicare & Medicaid Services (DMS):http://www.cms.hhs.gov/HIPAAGenInfo/Downloads/HIPAALaw.pdf.• Department of Health and Human Services (HHS): http://www.hhs.gov/ocr/privacy/index.html.Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1992 (S. 1306)TRICARE Policy Manual 6010.54-M, TRICARE Overseas Program (TOP), Chap. 12, Sec. 11.1 — Managed CareSupport Contractor (MCSC) Responsibilities for Claims Processing. Aug. 1, 2002: http://www.tricare.mil/tp02/C12S11_1.PDF.
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