Medical Management Guide, 2009, Version 3.0 - Tricare

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Instructions:When accessing this Guide from the CD-ROM:1. Links to outside websites and CD-ROM Resources will open inthe same browser window as this Guide. When accessing theselinks, use your browser’s “Back” button to return to this Guide.2. The CD-ROM Resources are saved as browser-viewable AdobeAcrobat PDF files and other native file formats from programs suchas Microsoft Word, Excel, PowerPoint, etc. These programs must beinstalled on your computer for access.A note about hyperlinks to outside websites: Links to outside websites found printedhere are provided only as a convenience to assist you in locating information that may behelpful. You should note that changes may occur since the printing of this Guide which mayaffect the accuracy or availability of the referenced link.All contents © 2009 DoD/Office of the Chief Medical Officer (OCMO)/TRICARE ManagementActivity (TMA) and the various other organizations whose work is reproduced here.
Medical Management Guide Version 3.0 Executive SummaryPage iiiExecutive SummaryINTRODUCTIONThe Department of Defense (DoD) TRICAREManagement Activity (TMA) values all staffinvolved in the delivery of high-quality healthcare to DoD beneficiaries — Service members andtheir families. TMA is constantly working to providethe most current information to its partners in thiseffort.The Medical Management Guide is issued by theOffice of the Assistant Secretary of Defense forHealth Affairs (ASD [HA]) and TMA, Office of theChief Medical Officer (OCMO), Population Healthand Medical Management Division (PHMMD).The Guide covers the components of a MedicalManagement (MM) program, including applicableprinciples, implementation concepts, processes, andtools/databases for Utilization Management (UM),Case Management (CM), and Disease Management(DM). It complements the 2001 DoD PopulationHealth Improvement Plan and Guide published byTMA and the Government Printing Office (http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf, and CD-ROM Resource ES-1).The ASD (HA) annually signs a five-year performanceplan for the Defense Health Program (DHP) with theSecretary of Defense, along with Army, Navy, andAir Force Assistant Secretaries for Manpower andReserve Affairs. MM-related measures (i.e., metrics)highlighted in the FY 2009 DHP Plan ( CD-ROMResource ES-2) include:• Beneficiary satisfaction with the health plan.• Inpatient production target (relative weightedproducts [RWP]).• Outpatient production target (relative valueunits [RVUs]).• Primary care productivity (RVUs per primary careprovider per day).• Medical cost per member per year.LEGISLATIVE GUIDANCEUnder legislative mandates, the ASD (HA)submits an annual report to Congressregarding healthcare delivery for 9.4 millionMilitary Health System (MHS) beneficiaries. The2009 report documents the MHS goal of providinghigh-quality care, improving performance throughclinical and process outcomes, and increasingpatients’ confidence in the care they receive.Version 3.0 of the Guide draws more specificallyfrom the Report to Congress on the ComprehensivePolicy Improvements to the Care, Management and
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Medical Management Guide, 2009, Version 3.0 - Tricare

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