1. Case Management Policy and Guidance
Angela Braithwood, RN, BSN
Senior QA Analyst, Case Management Services
Skyline Ultd.

2. Objectives Army Case Management Overview Policy and Guidance
Training and Education Requirements
CMSA and Certification

3. Army Case Management Model
DoD
Focus on education and training of CM’s
Inclusion Criteria for MND
Army – WTU’s and MMC
Based on CMSA Standards
Core competencies
AC-centric: No reserve component model
National Guard – Varies by State
No official guidance from NGB
DTM (Last Updated July 2012)
MEDCOM OPORD (Dated 2 Jan 2013)

4. Warrior Transition Command
Where we all started
Initial concept 1994
Initial development 2004
Formalization to WTC in 2005
CPL Kendra Coleman recovers at Walter Reed National Military Medical Center after losing her left leg in Afghanistan
Thought about after Gulf war, but not thoroghly developed b/c decreased casualty numbers
Put into serious practice three years into Iraq/Afghanistan
More serious survivable injuries – needing complex care
Difficulty with injured soldiers navigating health care system
Modeled after civilian practice, then became all its own

5. Applicable Policies for Case Managers
Case Management Society of America Standards of Practice for Case Management (2010)
CMSA Core Curriculum for Case Management, 2nd Edition. Suzanne K. Powell & Hussein A. Tahan. Philadelphia: Lippincott, 2008
Department of Defense TRICARE Management Activity Medical Management Guide Version 3.0
DTM , Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health System
DoDi , Medical Management
MEDCOM Soldier Medical Readiness Campaign
HQDA EXORD , Healing Warriors
MEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP)
MEDCOM OPORD 11-20, Patient Centered Medical Home
MEDCOM OPORD 10-66, Medical Management Centers
Comprehensive Transition Plan Guidance
Each policy has it’s own set of references as well – lots to read.
(f) Appendix E, MHS Coding Guidance 2012
(j) MEDCOM OPORD 12-16, Patient Caring Touch System of Care (hospital based) – applicability to RC? – Mobilization?
(m) MEDCOM OPORD 11-38, TeamSTEPPS
(n) Armed Forces Reportable Medical Events Guidelines, March 2012
(o) Preventive Medicine, AR 40-5, 25 May 2007
(p) Clinical Quality Management, AR 40-68, 26 Feb 2004/ RAR 22 May 2009

6. DoDi 6025.20 Medical Management (2006)
Establishes Medical Management Care Model within the MHS
Utilization Management
Case Management
Disease Management
Integration and coordination of services
Quality, completeness, and adequacy of total health care
Outcome Management

7. DTM (July 2012)
Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health System
Originally released Aug 2009
All-service and component requirements
Basic education, certification, and training
Performance Measures
Documentation/Coding
Take aways: The “must do” for all services and components

8. CMSA Standards of Practice
The Professional Organization of Army Case Management
*How* to do case management and standards

9. TRICARE MMG
Military Health System Guide to Case Management

10. MEDCOM OPORD 13-25 Nursing Case Management Guidance
Consolidation of references
Across all components
5 lines of effort
CM ID
Training/Education
Performance standards
Quality outcomes/measurement
Strategic communication
Take aways:

11. Army National Guard Case Management
Goal – Reduce Medically Not Ready population to maximize number of Soldiers available for mobilization/deployment
PHA/SRP/SRC Support
LOD/IDES Preparation
Remote Care
Telephonic Case Management
Electronic Database Systems
REFERENCES
Mobilization AR
PPG -
USCENTCOM Z DEC 11 MOD ELEVEN TO USCENTCOM INDIVIDUAL PROTECTION AND INDIVIDUAL-UNIT DEPLOYMENT POLICY
Community Resources
VHA

12. MEDCOM Soldier Medical Readiness Campaign 2011-2016
Strategic Level Medical Readiness Plan
Population Health
ID, Mgt, Health Promotion
Performance Measures
Commo

13. MEDCOM OPORD 10-66, Medical Management Centers
Closest to what we do at the AC level
Manages MNR Population
Collaboration with Units
Expands use to the RC
We did it first, but USAR is behind the curve.

14. Triad of Care OSS G-1 SM UNIT PCM SM SQD LDR NCM ARNG WTU
AC based on active, clinical CM
RC based on non-clinical CM
OSS
G-1 SM
UNIT
PCM
NCM SM
SQD LDR

15. ARNG Case Management Environment

16. Training and Education
MHS Learn
Case Management Track
Miliman Ambulatory Care
Core Curriculum
Army CM Course
Essentials of Case Management (fee)
Miliman training TBD – no access yet.

17. MHS Learn Case Management Training

18. Competency Assessment
First page only.

19. CMSA and Certification
Army prefers Certified Nurse Case Managers.
AC has CCM course for ANC and DA
No RC course/track yet
Fee-based course for all others

20. Questions?

21. Backup/Reference Slides

22. Comprehensive Transition Plan Guidance
WTU Action Plan for Soldiers
Two Tracks
Remain in the Army
Transition out of the Army
Closely tied with MTF’s and PCMH

23. HQDA EXORD 118-07, Healing Warriors
Part of the Army Medical Action Plan (AMAP)
Involvement of all Commands (IMCOM, MEDCOM, etc)
WTU’s more widespread (one at each MTF)
Triad of Care
Soldier and Family Assistance Centers (non-medical)
FRAGOS
1: Administrative changes to staff visits, add more specific tasks to Chiefs of Staff, adjust focus
2: SFAC setup
3: Refining WTU screening and entrance criteria
4: Reserve Component Remote WTU focus
Once the Army realized that they needed much more resources aimed at ill and injured soldiers, this OPORD came out to officially set up WTU’s and SFAC’s to assist the SM and their family with transition.

24. Incorporates HQDA EXORD 118-07 tasks to MEDCOM
MEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP)
Incorporates HQDA EXORD tasks to MEDCOM
Tasks RMC’s with AMAP deadlines
Streamlines Soldier and Family transition
Sets up TDA and Unit criteria
Some tasks were taken out of the HQDA EXORD and given to subordinate units (MEDCOM)
All FRAGOs incorporated into Consolidated document
VERY Specific guidance – includes websites and appendicies

25. MEDCOM OPORD 11-20, Patient Centered Medical Home
MHS Primary Care Model
Part of Access to Care Campaign (2008)
100% direct care enrollees in a PCMH NLT FY 2015
Utilization Management
Based on NCQA Standards for PCMH
NCQA – National Committee for Quality Assurance
Is your Soldier in a Primary Care PCMH? Ask!

26. AR 40-501 Standards of Medical Fitness
The Bible
AR Standards of Medical Fitness

27. MMPS Each case meeting assures: 1) temp profile updated as warranted
Case Manager(CM)
-reviews case
- assigns to
Care Coordinator (CC)
MRNCO
-assist SM w records/profiles BN monthly report
- hand off to CM
CC continues to
- assist SM
CC continues to
- assist SM
- coordinate w
CM/MRNCO as
needed
- coordinate w
CM/MRNCO as
needed
0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO
Temp profile written (issue found by self report, PHA, PDHA,
PDHRA)
Case meeting #1 CMD/SS/G1 and CM
Case meeting #2
CMD/SS/G1 and CM
Case meeting #3
CMD/SS/G1 and CM
MRDP
Not reached MRDP ?
May get ONE TIME temp prof extension per SS
Every 90 days (case meeting) the temporary profile should be amended – if no amendment is required by the 90 day timeline then the issue/condition has either been resolved or ready for permanent profile.
Each case meeting assures:
1) temp profile updated as warranted
2) eval for AD orders for medical care (WTU/RCMC)
3) eval for MMA assignment (option for CMD) 27

28. The Physical Performance The Physical Disability
Evaluation System
Recording Procedures
The Physical Disability
Evaluation System
A provider determines that a soldier has a medical limiting condition
Soldier meets
Retention Standards
Soldier does not meet Retention Standards
Appropriate profile is issued
Appropriate profile is issued
Medical condition is non-duty related
Medical condition is duty related
Temporary Profile is issued
A Permanent 2 Profile is issued
A Permanent 3 Profile is issued
Soldier elects a non-duty PEB
Soldier is referred to MEB
Soldier recovers
Soldier is issued a permanent profile
PEB - Fit
PEB - Unfit
Soldier continues with physical disability processing
Soldier is referred
to MAR2
PEB - Fit
PEB - unfit
Soldier is retained in MOS
Soldier is retained with a change in MOS
Soldier is retained with a trial duty
Appropriate disability is awarded
Legend
Medical Action
Military Personnel Action
Active Component Action
MAR2 – MOS Administrative Retention Review
MEB – Medical Evaluation Board
PEB – Physical Evaluation Board
Soldier returns to duty
Soldier receives Administrative Discharge