Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 166Appendix C - DefinitionsVersion 3.0Medical Management GuideResources:DoD Manual 6015.1-M, Glossary of Healthcare Terminology (January 1999): http://www.dtic.mil/whs/directives/corres/pdf/601501m.pdfSee CD-ROM Resource AppendixC-Def 1Custodial Care Transition Policy, TRICARE: http://manuals.tricare.osd.mil/.Demand ManagementA collection of proactive interventions focused on reducing unnecessary healthcare utilization whilesimultaneously encouraging the appropriate use of healthcare resources.Resources:DoD Population Health Improvement Plan and Guide, p. 43 (December 2001): http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.See CD-ROM Resource ES-1Diagnosis-Related Group (DRG)A patient classification system that relates demographic, diagnostic, and therapeutic characteristics of patientsto length of inpatient stay and amount of resources consumed. It provides a framework for specifying hospitalcase mix and identifies classifications of illness and injury for which payment is made under prospective pricingprograms.Resources:DoD Manual 6015.1-M, Glossary of Healthcare Terminology (January 1999): http://www.dtic.mil/whs/directives/corres/pdf/601501m.pdf.See CD-ROM Resource AppendixC-Def 1Disability Evaluation System (DES)The purpose of the DES is to maintain a fit and vital force. According to DoD regulations, the DES shouldinclude a Medical Evaluation Board (MEB), a Physical Evaluation Board (PEB), an appellate review process, and afinal disposition. Service members should be assigned a Physical Evaluation Board Liaison Officer (PEBLO) to helpthem navigate the system.Resources:Deployment Health Clinical Center: http://www.pdhealth.mil/hss/des.asp.See Section III, Case ManagementDischarge PlanningThe development of an individualized discharge plan for the patient prior to leaving an institution for home,with the aim of improving patient outcomes, reducing the chance of unplanned readmission to an institution,and containing costs.
Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 167Resources:TRICARE Operations Manual 6010.51-M, Appendix A, Acronyms and Definitions (Aug. 1, 2002): http://www.tricare.mil/to02/APPA.PDF.See AppendixC-Def2Disease Management (DM)• A system of coordinated healthcare interventions and communications for populations with conditions inwhich patient self-care efforts are significant.• An organized effort to achieve desired health outcomes in populations with prevalent, often chronicdiseases, for which care practices may be subject to considerable variation.An organized effort to achieve desired health outcomes in populations with prevalent, often chronic diseases,for which care practices may be subject to considerable variation. DM programs manage populations and useinterventions that are evidence-based. The term “condition management” is also used to include non-diseasestates, such as pregnancy.Resources:Disease Management Association of America (DMAA): The Care Continuum Alliance: http://www.dmaa.org/dm_definition.asp.DoDI 6025.20, Medical Management (MM) Programs in the Direct Care System (DCS) and Remote Areas:http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.Kongstvedt, P.R. Essentials of Managed Health Care, 5th ed. Jones and Bartlett Publishers, 2007.DoD Population Health Improvement Plan and Guide, p. 43. December 2001: http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.Exceptional Family Member Program (EFMP)See also Military OneSourceThe Military Services use the term Exceptional Family Member Program (EFMP) to refer to two differentfunctions: a personnel function and a family support function. The EFMP family support function is notmandatory. DoD policy allows, but does not require, the Services to offer family support services to EFMswithin their family support systems.In the Army and Marine Corps, EFM support staff are called EFMP Managers (Army) or EFMP Coordinators(Marine Corps).In the Navy, the EFMP staff that support the personnel function may also provide family support services, butthe Navy does not staff their family centers with EFMP Coordinators. In the Air Force, special needs staff arelocated in the Military Treatment Facility (MTF) only.Resources:DoDI 1342.22, Family Centers, Dec. 30, 1992: http://www.dtic.mil/whs/directives/corres/pdf/134222p.pdf.
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