Case Management
Case Management (CM) is a key clinical process that supports the MHS’s ability to provide seamless continuity of care through the coordination of needed services to meet beneficiaries’ health care needs. The TRICARE Management Activity (TMA) focuses on three CM areas: 1) Policy, 2) Education and Training, and 3) Information Management/Data Sharing. The TMA Office of the Chief Medical Officer (OCMO) developed an interim policy for the implementation of clinical CM in the MHS. CM web-based and virtual instructor-led training via the MHS Learn platform also are being developed. TMA continues working toward acquisition of an enterprise-wide automated CM tool to assist with documentation and tracking of a patient’s individualized care plan.
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Disease Management
The goals of Disease Management (DM) is to improve health status (clinical outcomes), increase patient and provider satisfaction, and ensure appropriate utilization of resources. Currently, the MHS DM program addresses asthma, congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disease (COPD), depression and anxiety. Further expansion, to include cancer screening is expected in FY2011. The Department is pursuing necessary regulatory changes to implement DM as a full benefit, in accordance with the John Warner National Defense Authorization Act (NDAA) for FY2007; Section 734: Disease and Chronic Care Management.
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Utilization Management
The purpose of Utilization Management (UM) within each MTF is to identify, monitor, evaluate, and resolve issues that may result in inefficient delivery of care or that may have an impact on resources and services. UM at the MTF level is accomplished through ongoing proactive data analysis, utilization review, CM, and referral management.
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