Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 178Appendix C - DefinitionsVersion 3.0Medical Management GuideResources:Army: AR 635-40, Physical Evaluation for Retention, Retirement, and Separation (Feb. 8, 2006):http://www.army.mil/usapa/epubs/pdf/r635_40.pdf.Army: AR 600-60, Physical Performance Evaluation System (Feb. 28, 2008):http://www.army.mil/usapa/epubs/pdf/r600_60.pdf.Air Force: AFI 36-3212, Physical Evaluation for Retention, Retirement, and Separation (Feb. 2, 2006): http://www.af.mil/shared/media/epubs/AFI36-3212.pdf.DoDD 1332.18, Separation or Retirement for Physical Disability (Jan. 5, 2006): http://www.dtic.mil/whs/directives/corres/pdf/133218p.pdf.Population HealthPopulation-based health care improves the health status of all our beneficiaries by delivering proactive, efficient,and effective evidence-based interventions in partnership with our patients.Resources:2001 DoD Population Health Improvement Plan and Guide: http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.See CD-ROM Resource ES-1Predictive ModelingA set of tools used to stratify a population according to its risk of nearly any outcome. Ideally, patients are riskstratifiedto identify opportunities for intervention before the occurrence of adverse outcomes that result inincreased medical costs.A technological tool that functions as an electronic claims canvasser searching for predefined variables ofinterest. This tool is used to identify high-cost diagnoses that, in turn, provide a risk score indicative of thelikelihood to utilize more healthcare resources and dollars than persons of the same age and gender.Resources:Cousins, 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.Kongstvedt, P.R. Essentials of Managed Health Care, 5th ed., 378-379. Jones and Bartlett Publishers, 2007.See CD-ROM Resources MME-1 and MME-2Carlson, B. Predictive Modeling, Sharp Lens on Near Future. Managed Care, July 2003. MediMedia USA:http://www.managedcaremag.com/archives/0307/0307.predictive.html.Hodgman, S.B., BS, MSc, RN, CPUM. Predictive Modeling & Outcomes. Professional Case Management, 13:1,19–23, January/February 2008: http://www.nursingcenter.com/prodev/ce_article.asp?tid=765747.
Medical Management Guide Version 3.0 Appendix C - DefinitionsPage 179Primary Prevention(see also Secondary Prevention, Tertiary Prevention)A stage of Medical Management that occurs when the goal is to avert or slow the onset or incidence ofdisease.Resources:2001 DoD Population Health Improvement Plan and Guide: http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.See Executive Summary, CD-ROM Resource ES-1Wilson, 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.ProfilingThe collection and analysis of clinical utilization data to produce specific information on resource consumptionand outcomes of care.Resources:Kongstvedt, P.R. Essentials of Managed Health Care, 5th ed. Jones and Bartlett Publishers, 2007.Kongstvedt, P. R. The Managed Health Care Handbook. Aspen, 2007.Program for Persons with Disabilities (PFPWD)See Extended Care Health Option (ECHO)Recovery Care Coordinator (RCC)See also Federal Recovery Coordinator, Recovery Care Plan, Recovery Coordination ProgramThe ultimate resource for wounded, ill, and injured Service members and veterans, and their families. This roleoversees the development and delivery of services/resources through the comprehensive recovery care plan inconjunction with multi-disciplinary teams (MDTs), to ensure quality care and accountability.Resources:National Resource Directory: http://www.nationalresourcedirectory.gov/.Department of Veterans Affairs (VA): http://www.va.gov/JOBS/Fed_Recover_Coord.asp.See CD-ROM Resources CM-25, CM-26, CM-27, CM-28, CM-29, CM-30, CM-31, CM-32Recovery Care PlanSee also Recovery Care Coordinator, Recovery Coordination ProgramAn individualized, integrated, longitudinal, medical/nonmedical service plan across the continuum of care tomeet personal and professional goals of wounded, ill, and injured Service members and veterans, and theirfamilies.Resources: See Recovery Coordination Program
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