Medical Management Guide, 2009, Version 3.0 - Tricare

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Page 20 Medical Management EssentialsVersion 3.0Medical Management GuidePROGRAM SUSTAINMENTProgram sustainment is a frequentlyoverlooked step that should begin uponinitiation of new programs. It is important forthe MM plan to match the needs of the organizationand its primary stakeholders. In the MTF, providerstransfer and deploy. This means new providersare always entering the system, along with newbeneficiaries. It is therefore crucial to continuouslypromote your services to healthcare team members,patients, and families; and to educate them on howto refer.Leadership and organizational culture are key factorsin effective program sustainment. With this in mind,the MM plan should:• Develop a leadership strategy to gain and maintainsupport at all levels of the organization.• Clearly describe the benefits of the program andregularly report on its progress to stakeholders.• Include feedback from patients, providers, andother healthcare team members.• Build a seamless organizational culture byintegrating MM with other MTF programs.• Make sure MM program data are communicatedas feedback to clinical and executive staff.o Providers must be actively engaged as keymembers of the MM team.o Practice patterns must change to meetthe goal of clinical and financial outcomesimprovement.An important sustainment strategy is to promote theMM program through marketing. Marketing involvesplanning and executing the conception, promotion,and distribution of services that satisfy individualand organizational objectives.To develop a successful marketing strategy, you mustfirst define the services your department has to offer.Ask questions such as the following: Do we currentlyhave MM services? If working in an inpatient facility,does that facility require discharge planning?The next step is to determine the target audience.Do you market only to your healthcare providers ordo you allow patients and their families to self-refer?Understanding your organization’s mission will helpyou develop your plan. Where does the organizationneed you to focus your services? On patients withhigh utilization? On wounded, ill, and injured Servicemembers? On patients with complex needs? OnADSMs, family members, or retirees? Who is usingmost of the organization’s resources?After developing the plan, it is time to promoteyour services. Suggestion: Develop brochures forproviders and for patients, for the different servicesyou offer, or for all services ( CD-ROM ResourceMME-4 provides a sample MM marketingbrochure; see also Section III, Case Management,CD-ROM Resource CM-23). It may be useful todevelop a simple reference pocket card for providersfeaturing trigger diagnoses for referral, screeningcriteria, how to refer, and a phone number to callwith questions.Other methods for promoting your services include:• Speaking at professional staff meetings.• Communicating with your organization’sleadership.• Advertising in the clinic or hospital newsletter.
Medical Management Guide Version 3.0Medical Management EssentialsPage 21Explain the benefits of using your services to theprovider, patient, and family. The initial challenge isto gain exposure.SUMMARYTo successfully implement MM in the MTF,MM staff should incorporate PopulationHealth principles and integrate evidencebased,business, and Resource Managementpractices. More specifically, MM program designshould reflect the integration of UM, CM, and DMfunctions to optimize patient outcomes. Leadershipsupport, active provider engagement, appropriateresource allocation, and inter/intradepartmentalcommunication all play a role in sustaining aneffective MM program.CD-ROM RESOURCESMME-1MME-2MME-3MME-4Department of Defense Instruction(DoDI) 6025.20, Medical ManagementPrograms in the Direct Care System (DCS)and Remote Areas (2006)Article: Meek, Julie A., DNS.:Predictive Modeling and Proactive CareManagement, Part I – Lippincott’s CaseManagement (July/August 2003)Article: Meek, Julie A., DNS.: IncreasingReturn on Investment Potential in CareManagement, Predictive Modeling andProactive Care Management, Part II –Lippincott’s Case Management(September/October 2003)Sample Medical Management MarketingBrochure – Air ForceMME-5* HA Policy Memo on Implementation forProspective Payment Systems (2004)MME-6* HA Policy on Right of First Refusal (2005)MME-7* HA Policy for Active Duty ServiceMember Enrollment to TRICARE Prime(2005)MME-8* HA Policy on Short-term Solutionsfor the Enterprise-wide Referral andAuthorization System (2005)MME-9* HA Interim Policy for MedicalManagementMME-10* Article: Despite Barriers, MCOs IntegrateCase, Disease, Utilization ManagementFunctions – Managed Care Week (March14, 2005)MME-11* Article: Mullahy, C. M. The EffectiveIntegration of Utilization and CaseManagement –The Case Manager (TCM)(March/April 2000)MME-12 Article: Wilson, Carneal, and Newman,Documenting Case ManagementOutcomes: Advancing The Science WhilePreserving The Art –Case In Point (CIP)(February/March, 2008)*Not referenced in text‘
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