Medical Management Guide, 2009, Version 3.0 - Tricare

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Page viiiAcknowledgementsVersion 3.0Medical Management GuideAir ForceCarol Andrews, Lt Col, NCDeona J. Eickhoff, Lt Col, NCSabrina M. Preston-Leacock, Lt Col, NCMelanie A. Prince, Lt Col, NCBrij B. Sandill, Lt Col, NCTammy R. Tenace, Lt Col, NCIwona E. Blackledge, Maj, NCShawn Dunne, Maj, NCKaryn L. Revelle, Maj, NCPaula M. Winters, Maj, NCSherry A. Herrera, MSN, NE-BC, CPUM, CMACBeverly K. Luce, MHSA, BSN, RN, CCMU. S. Department of Veterans AffairsKaren M. Ott, RN, MSNMilitary Patient Centered MedicalHome ModelThis model was used with permission from andwas created by the National Naval Medical CenterPatient Centered Medical Home and by CDR KevinDorrance, USN, MC.Cover PhotoSource: http://www.defenseimagery.mil/Photographer: MSgt Steve Cline‘IndustryTerry Kelley, BSN, RN, CCM — Case ManagementSociety of AmericaContractor SupportTechnology, Automation and Management(TeAM), Inc.• Charles G. Davis, CEO, Program Manager• Anne F. Cook, Technical Writer/Editor• Keira R. Thrasher, Senior Curriculum Developer• Syreeta M. Collier, Logistics Coordinator• Valerie Thompson, Graphic Designer
Medical Management Guide Version 3.0Page ixTable Of ContentsClick text listing to viewExecutive Summary..................................................................................................................................... iiiIntroduction............................................................................................................................................................ iiiLegislative Guidance................................................................................................................................................ iiiDescription of Guide Contents................................................................................................................................ ivContact Information................................................................................................................................................ viCD-ROM Resources................................................................................................................................................. viAcknowledgements ........................................................................................................................................... viiSection I – Medical Management Essentials.......................................................................................... 1Introduction............................................................................................................................................................ 1Definition of Medical Management.................................................................................................................. 1Primary Care Management Team Approach...................................................................................................... 2Policy Requirements for Medical Management within the Direct Care System................................................... 4Medical Management Goals and Approach...................................................................................................... 5The Link between Medical Management and Population Health.............................................................................. 7Population Health Elements in Action............................................................................................................... 8TRICARE and Other Benefit Programs..................................................................................................................... 10Working with Managed Care Support Contractors........................................................................................... 10The Link between Clinical and Business Operations................................................................................................. 11Integrating Utilization, Case, and Disease Management Functions........................................................................... 12Staffing for Combined Functions...................................................................................................................... 16Essential Considerations for Medical Management Staff.......................................................................................... 18Benefitting from Information Technology.......................................................................................................... 18Privacy and Confidentiality of Patient Information............................................................................................. 19Program Sustainment.............................................................................................................................................. 20Summary................................................................................................................................................................ 21CD-ROM Resources................................................................................................................................................. 21
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