Docstoc

Tobacco - Alcohol - Obesity - PowerPoint

Document Sample
Tobacco - Alcohol - Obesity - PowerPoint Powered By Docstoc
					    Welcome to the MHS
Disease Management Summit




       8 September 2005
                                    Agenda
0800 – 0805   Welcome and Administrative Remarks
0805 – 0835   TMA Medical Management Overview
              Disease Management (DM) Contract Requirements
              DoD/VA Clinical Practice Guidelines
0835 – 0935   Health Net, Humana, & TriWest DM Overview
0935 – 0950   Break
0950 – 1010   USFHP DM Overview
1010 – 1110   Army, Navy, & AF DM Overview
1110 – 1140   Business Planning…Incentives & Obstacles
1140 – 1220   Working Lunch
1220 – 1300   Guest Speaker Presentation
              CMS, Division of Chronic Care Improvement Programs
1300 – 1320   Johns Hopkins "Telewatch" Presentation
1320 – 1340   Innovations on the Horizon: Financial Incentives
              for Healthy Lifestyles, Pay for Performance Proposal
1340 – 1350   Break
1350 – 1450   Round Table Discussion: The Way Ahead
1450 – 1500   Final Remarks
                                                                     2
MHS Disease Management Summit
   Medical Management Overview




   Director, Population Health and Medical Management
            Office of the Chief Medical Officer
                    8 September 2005


                                                        3
                               Overview

• Medical Management (MM)…What is it & Why Should you Care?
   – Utilization Management (UM)
   – Case Management (CM)
   – Disease Management (DM)
• Linked to Population Health
• Critical to Business Planning Success
• Contractor DM Requirements
• HA/TMA Support
   – On-Site & On-Line Training & Consultation
   – DoDI and MM Guide




                                                              4
Medical Management Model




                           5
                    Medical Management

Medical Management - integrating key processes Utilization, Case &
                       Disease Management
• Utilization Management - an organization-wide, interdisciplinary
  approach to managing care
    – Includes Referral & Demand Management
• Case Management - collaborative process of providing services to
  meet complex health needs while promoting quality, cost-effective
  outcomes
• Disease Management - system of coordinated healthcare
  interventions for populations with conditions which require significant
  patient self-care efforts



                                                                            6
       Linked to Population Health

Four of seven steps to Pop Health improvement
                  involve MM

               Identify Population
               Forecast Demand
               Manage Demand
               Manage Capacity

  …and provide business planning inputs


                                                7
        Critical to Business Plan Success

    MM is key to accomplishing business plan
• MTFs must manage demand
  – Use DM & CM to keep high utilizers in control
  – Monitor direct & purchased care
• How?
  – Know utilization patterns and control them
     • Reviews in Referral Management Centers
     • Use Decision Support tools—Interqual & Milliman
     • Prevent unnecessary referrals, manage Right of First
       Refusal (ROFR)
  – Manage capacity
     • Guarantee access to care in the Direct Care System


                                                              8
           Direct Care MM Requirements

• Develop an integrated MM plan
   – Based on MTF’s business plan
   – Assure multidisciplinary team input
   – Incorporate monitoring activities in plan
   – Monitor CPG outcomes & compliance
• Qualified, trained staff
• Denial of care appeals process in place

• Assure interface w/contractor on MM issues



                                                 9
             Contract DM Requirements
               C-7.7.1. Operate programs designed to:


• Manage health of those with high-cost conditions or specific
  diseases
• For which proven clinical management programs exist
• Available to TRICARE eligibles who receive civilian care
  reimbursement (per 32 CFR 199)
• Available to AD receiving most or all care in network
• When care occurs in MTF, contractor is responsible to coordinate
  care with MTF clinical staff as well as civilian providers


                                                                     10
               HA/TMA Support

• HA Policy Letter 04-008: Interim MM Guidance
• Medical Management Guide
     • Job descriptions/SOWs, many tools
     • “How to” guide for new programs
• Draft MM DoDI final in next month
• Training and Consultation opportunities
   – On-Line and On-Site Courses
   – Trained over 800 direct care personnel (14%)
   – Consult with Services and MTFs


                                                    11
                      Questions?

Point of Contact:
Director, Population Health and Medical Management

DSN: 761-0064     Comm: 703-681-0064


Web site for courses, guide, references:
http://www.dodmedicalmanagement.info




                                                     12

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:83
posted:3/25/2008
language:Latin
pages:12