AMEDD Semi-Monthly Update - Get as DOC

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					                                TRO-South Messenger
                             A Bi-Weekly Update for the Region
                                         Issue 13
                                    February 21, 2010

              This publication can be viewed on the TRO-South website at
       Previous editions can be found at


Communication is key. Network provider turnover happens in all health plans. Historically,
the managed care support contractors’ networks enjoy very low rates of provider turnover.
When a provider leaves the network, however, it can be very disruptive to beneficiaries who
have established trusted care relationships with the departing provider. Most often, changes
are handled by moving the patient to another caregiver or allowing them to choose another
provider. Other times, when the provider cares for a large number of TRICARE patients or
if the circumstances become emotionally charged, the situation becomes more like a
contingency operation.

It is important to be alert for the first signs of an impending loss of a significant network
provider. Alerts regarding such losses often come in the form of verbal or written patient
inquiries, congressional inquiries, information from MTF staff, notification from the departing
provider, local media coverage or notification from TRICARE contractor partners.

Regardless of the source of the alert, immediate action must begin. If, after a review of the
facts of the situation the loss of the provider cannot be averted, working collaboratively with
all stakeholders on the development of a plan to assure that services for affected
beneficiaries are reestablished with other providers is job one.

From our experience, processes/actions that work well include:

   Rapid, direct and personal assistance to affected beneficiaries, to include:
       Identify individuals, contact the beneficiary (calls and in writing), assess their needs,
        assess the ability of the network to meet these needs, and offer assistance with
        transferring them to another provider. Identify any special needs beneficiaries that
        may require extra assistance. Follow up with beneficiaries within 30 days to be sure
        the new arrangements are working.
       Rapidly establish a contingency communication response group. Frequency of
        updates is based upon the acuity of the situation, but at least weekly until resolution.
       Communicate updates with all key parties as appropriate.
         - Beneficiaries
         - MTF commander, MTF contract liaison, MTF BCACs
         - Installation public affairs
         - Intermediate Commands

        - Service HQs
        - Media – Have one POC for questions and comments
        - Congressional offices
        - Special interest groups
      Produce consistent, repeated communication in the form of talking points, scripts for
       call-outs/call-ins, press release and/or Q&As.

Ensuring that beneficiaries are supported when a significant network provider leaves
requires coordinated effort and excellent communication among the contractor, MTF
personnel, other stakeholders and the Regional Office.

Respectfully, Martha Lupo, Chief Operating Officer

TRO-South POC: (210) 292-3233

complex responsibilities at home and overseas the Military Health System has adopted the
Quadruple Aim model of care. Rear Adm. Christine Hunter, deputy director of the
TRICARE Management Activity, told a standing-room only crowd of military medical leaders
on January 28, 2010 at the Military Health System (MHS) Conference. The Quadruple Aim,
she explained, supports readiness, population health, a positive patient experience and
responsible management of health care costs.

During the 2010 Military Health System (MHS) conference, key speakers described the
scope and complexity of military medical operations and the TRICARE program. The MHS
is becoming increasingly complex, Hunter said, and must create a learning culture to
develop the next generation of leaders ready to adapt to unforeseen circumstances. MHS
leaders, she said, are adopting a learning culture to share knowledge.

The MHS is responsible for the care of 9.6 million people. In a single week, 1.6 million
outpatients are seen, 2.48 million prescriptions are filled and 3.5 million claims are paid.
Hunter congratulated all of the providers who have supported the ongoing relief efforts in
Haiti while they handled TRICARE’s regular workload.

―Active, reserve, civilian and network partners came together immediately in an inspiring
demonstration of teamwork,‖ Hunter said of the effort.

Hunter discussed the Quadruple Aim, which she began implementing in July 2009 soon
after her arrival at TMA, explaining how it is designed to help achieve near-term goals and
guide long-range planning.

―The MHS has been successful in achieving three parts of the Quadruple Aim – readiness,
population health and cost management,‖ Hunter said.

Ending her speech, Hunter impressed upon the more than 3,000 MHS professionals in
attendance the importance of their jobs, and urged them to continue the great work they do.
She closed by emphasizing how attendees can help achieve MHS goals by promoting
individual and family readiness, a healthy population, positive patient experiences and
responsible management of health care costs.

―You personally can help us achieve the Quadruple Aim,‖ Hunter said ―by ensuring that
patients with an acute minor condition contact their primary care manager or visit an urgent
care center rather than the emergency room, transfer brand name prescriptions from retail
pharmacy to home delivery and that patients get the right information the next time they
interact with us.‖

TRO-South POC: (210) 292-3278

(TRO) and TRICARE Area Office (TAO) has a Senior Enlisted Leader (SEL) standing by to
assist you?

The role of the SEL is to serve as an advocate on healthcare issues that affect active duty,
Reserves, National Guard, retired military personnel and family members within the military
healthcare system.

SELs also work closely with the Senior Enlisted Advisor for the Office of the Asst. Secretary
of Defense for Health Affairs (OSD/HA) and the TRICARE Management Activity (TMA) to
enhance outreach opportunities and help resolve systematic TRICARE issues.

Navigation through the military healthcare system requires a team approach—from BCACs
to TSC personnel, from First Sergeants to first-line supervisors, from military members and
their families to all the support personnel in between—and together we can and will make a

Please feel free to contact any of us with issues that arise and we will do our best to resolve
them. We look forward to working with each and everyone of you in providing our
beneficiaries the best healthcare!

OSD/HA & TMA SEA:                  SGM Robert Wojtaszczyk (USA)

TRO South SEL:                     SMSgt Nicole McClain (USAF)

TRO North SEL:                     MSG Christopher Aleong (USA)

TRO West SEL:                      HMCM Carl Fritts (USN)

TAO Pacific SEL:                   HMCS Joseph Galang (USN)

TAO Eurasia-Africa SEL:            MSgt Denean Willis (USAF)


For more information about the regional SELs, go to

TRO-South POC: (210) 292-3228

will be on the road to recovery more quickly and efficiently thanks to a growing list of
programs offered by the Office of Wounded Warrior Care and Transition Policy (WWCTP).

―We want to provide every possible option of recovery to all the branches of service. Our
goal is to empower and encourage service members to return to duty,‖ said Pam
McClelland, director of coordination operations, WWCTP, at the 2010 MHS Conference.

The Office of WWCTP was formed in November 2008 and aims to ensure that wounded
warriors and veterans have employment and benefit opportunities as well as a smooth
transition back into duty or civilian life.

Disability Evaluation System

The DoD and VA are collaborating to administer the Disability Evaluation System (DES),
which provides one exam, one rating, and one assessment for wounded service members
to determine their level of disability. The system, which is still in the pilot stages, will give
wounded warrior programs increased transparency and faster processing. Officials hope to
expand the DES to six new sites by the end of February.

Recovery Care Plan

As part of a new Recovery Care Plan (RCP), Recovery Care Coordinators, or RCCs, will be
hired and trained by the DoD and wounded warrior programs to assist in service member
transition. The RCCs will work to meet the non-medical needs of service members, and
also partner with commanders to make sure the RCP is completed and implemented. Policy
regarding the RCCs and RCP was signed in December of last year and should make these
services available to Guard and Reserve service members later in 2010.

Transition Assistance Program

The Transition Assistance Program (TAP) connects transitioning service members with
counselors, provides benefit briefings, and employment workshops. The WWCTP and other
warrior programs are currently working to modernize the TAP. The Web site for TAP
resources is

―Referring a warrior or a family member of a wounded warrior to a Web site may seem
impersonal, but we offer a list of great resources that are only a click away. It really does
help get the information out there,‖ said McClellan.

National Resource Directory

The National Resource Directory is an online resource for wounded warriors, their families,
and those who support them. The DoD teamed with the Department of Labor, and the VA
so that the National Resource Directory provides links to thousands of services and
available resources at the national, state, and local levels to support recovery, rehabilitation,
and community reintegration.

For more information, go to where this article was obtained.

DOT MIL DOCS: Located at Dot Mil Docs is part of the MHS’ ongoing
effort to interact with service members and the general public via ―Web 2.0‖ technology. It is
a weekly DoD-hosted Internet radio show. Military docs and health care experts discuss a
new topic each week. Thousands listen. Those who cannot listen when the show is live, can
listen to archived Dot Mil Docs broadcasts at under the video and audio
section. To set a reminder for the show, visit:

TRO-South POC: 210-292-3278


Click on the title to view information or visit:

  Military Medical Personnel Aid Haiti Relief, Maintain Presence at Home
  Preventive Services Come Standard with TRICARE
  New TRICARE Standard Handbook – Get e-Version Now
  TRICARE Expands Behavioral Health Care Options
  TRICARE Dives into Social Media to Engage Beneficiaries

TRO-South POC: 210-292-3278


MONITORING CLINICAL QUALITY OF CARE: The Department of Defense, through the
TRICARE Management Activity, has delegated the function of monitoring and managing the
clinical quality of care rendered to TRICARE beneficiaries in the purchased care system to
the Managed Care Support Contractor (MCSC). This function is vital to the protection of
TRICARE beneficiaries. In the South region, the MCSC is Humana Military Healthcare
Services (HMHS). Please note that this delegation and function does not apply to
TRICARE for Life beneficiaries.

Critical to the function of managing the clinical quality of care is the identification and
reporting of potential quality of care issues (PQIs). For beneficiaries enrolled to the direct
care system, the identification and reporting of PQIs for care delivered by civilian providers
is described in the South Region CORE MOU, Section III, G 15:
     -   HMHS is responsible for peer review of clinical quality issues for network providers. The
         MTF provides the same oversight for MTF providers. To ensure appropriate review and
         documentation when the MTF identifies potential quality of care issues that concern non-
         MTF providers, MTF quality personnel will notify the TRO Chief of Quality Management
         who will, in turn, notify the HMHS Regional Quality Manager of the issue. This notification
         will be logged into both the MTF and the HMHS peer review minutes. The same process
         will apply in reverse when HMHS identifies potential quality issues involving MTF
         providers, unless otherwise agreed by the TRO Chief of Quality Management.

Therefore, if an MTF provider/MTF staff identifies a PQI from a civilian provider, whether the
provider is network or non-network, please contact the POC below (TRO-S Chief, Quality
Management) for the appropriate referral to HMHS for review, investigation, and potential
intervention. Please understand that any PQI review falls under peer review protections
and cannot be disclosed back to the MTF.
TRO-South POC: (210) 292-3276,

TRIWORLD: As many of you may already know, Humana Military introduced TRIWORLD
last summer but chose to delay the full launch due to decisions concerning the TRICARE
contract. They have recently decided to proceed with the full launch and are asking your
help with promoting this initiative.

TRIWORLD is a 3D virtual world open to TRICARE beneficiaries in the South region. It
allows military families to stay connected when separated due to deployment or active duty
obligations. Access to TRIWORLD is free for active duty service members, active duty
service member families, retirees, and retiree family members. TRIWORLD will allow the
user to create and control his or her very own online, personalized character called an
―avatar.‖ Once avatars are created, they will be able to interact with loved ones and do
many everyday ―real world activities‖ like talking, walking and dancing. Users can discuss
medical benefits, share experiences, and enjoy activities and special events—almost like
being there in person. TRIWORLD users are able to visit with family and friends in these
five virtual settings:

• Welcome Center—Provides information about this virtual world and TRICARE
• Tropical Island— Allows users to enjoy water and beach activities like windsurfing
• Neighborhood—Includes features like individual homes and an interactive soccer field
• Overseas Military Base—Enables military members to show families their overseas living
  and work environments.
• Conference Center—Offers private meeting and press rooms. This virtual, closed
  environment is available to TRICARE South beneficiaries 24/7 to accommodate all time
  zones. Consultants are available in-world to provide one-on-one support, any time day or

To learn more, go to and click on the TRIWORLD link at the
bottom of the home page.
TRO-South POC: (210) 292-3278

CONSULTANT: If you’ve ever wondered where best to start identifying opportunities to
improve your organization’s operations, we suggest you consider requesting assistance
from your consultants at TRO-South and Humana Military, the South Region’s Managed
Care Support Contractor.

The TRO-South Business Operations Division is available to assist MTF leadership and
their staff with various optimization programs at their disposal. We welcome active
engagement with the MTFs for all business opportunities. We are always available to
consult, advise, receive feedback, and otherwise remain tightly connected to the region we

Humana Military can also provide senior leaders and staff with tailored information and
assistance in determining the best ways to optimize MTF assets in this constantly changing
patient care environment. As a dedicated resource, Humana Military is also deeply
committed to helping MTFs meet their mission requirements and provide outstanding,
efficient health care to their beneficiaries. They are pleased to generate, analyze, and
review data, as well as recommend possible courses of action for consideration. Humana
Military can provide comprehensive and detailed optimization briefings that can direct you to
significant potential areas of improvement. If your senior leadership is interested in taking
advantage of this free valuable service, please request such assistance either through your
Humana Military TRICARE Service Center Supervisor or directly to the Director, Clinical
Resources at Humana Military at (502) 301-6599. The Humana Military Clinical Resources
staff is available to provide optimization assistance to you and your staff.

Both TRO-South and Humana Military encourage you to contact us if we can be of
assistance to your senior leadership and staff, as you strive to improve upon your MTF’s

TRO-South POC: 210-292-3286/3245

Your feedback is very important to us and helps pave the way to enhancing the
service we provide.

If you would like to provide comments or feedback on the TRO-South Messenger or the
services provided by a TRO-South staff member, please access our online customer
feedback section located on our website at TRO-South Comment Card.

If you need immediate assistance with this publication, please call 210-292-3278.

Thank you!