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

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Presentation on theme: "Case Management Policy and Guidance Angela Braithwood, RN, BSN Senior QA Analyst, Case Management Services Skyline Ultd."— Presentation transcript:

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 CMs – Inclusion Criteria for MND Army – WTUs and MMC – Based on CMSA Standards – Core competencies – AC-centric: No reserve component model National Guard – Varies by State – No official guidance from NGB

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

5 Applicable Policies for Case Managers Case Management Society of America Standards of Practice for Case Management (2010) CMSA Core Curriculum for Case Management, 2 nd 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

6 DoDi 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

8 CMSA Standards of Practice The Professional Organization of Army Case Management

9 TRICARE MMG Military Health System Guide to Case Management

10 MEDCOM OPORD 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

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

12 MEDCOM Soldier Medical Readiness Campaign 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

14 Triad of Care ARNG OSSG-1 SM UNIT WTU PCMNCM SM SQD LDR AC based on active, clinical CM RC based on non- clinical CM

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)

17 MHS Learn Case Management Training

18 Competency Assessment

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 MTFs and PCMH

23 HQDA EXORD , Healing Warriors Part of the Army Medical Action Plan (AMAP) Involvement of all Commands (IMCOM, MEDCOM, etc) WTUs 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

24 MEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP) Incorporates HQDA EXORD tasks to MEDCOM Tasks RMCs with AMAP deadlines Streamlines Soldier and Family transition Sets up TDA and Unit criteria

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

26 The Bible AR Standards of Medical Fitness

27 27 MRNCO -assist SM w records/profiles - BN monthly report - hand off to CM Case Manager(CM) -reviews case - assigns to Care Coordinator (CC) CC continues to - assist SM Case meeting #1 CMD/SS/G1 and CM Case meeting #2 CMD/SS/G1 and CM CC continues to - assist SM Case meeting #3 CMD/SS/G1 and CM MRDP Not reached MRDP ? May get ONE TIME temp prof extension per SS Temp profile written (issue found by self report, PHA, PDHA, PDHRA) 0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MO - coordinate w CM/MRNCO as needed - coordinate w CM/MRNCO as needed 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) MMPS

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


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