Presentation on theme: "Case Management Policy and Guidance"— Presentation transcript:
1 Case Management Policy and Guidance Angela Braithwood, RN, BSNSenior QA Analyst, Case Management ServicesSkyline Ultd.
2 Objectives Army Case Management Overview Policy and Guidance Training and Education RequirementsCMSA and Certification
3 Army Case Management Model DoDFocus on education and training of CM’sInclusion Criteria for MNDArmy – WTU’s and MMCBased on CMSA StandardsCore competenciesAC-centric: No reserve component modelNational Guard – Varies by StateNo official guidance from NGBDTM (Last Updated July 2012)MEDCOM OPORD (Dated 2 Jan 2013)
4 Warrior Transition Command Where we all startedInitial concept 1994Initial development 2004Formalization to WTC in 2005CPL Kendra Coleman recovers at Walter Reed National Military Medical Center after losing her left leg in AfghanistanThought about after Gulf war, but not thoroghly developed b/c decreased casualty numbersPut into serious practice three years into Iraq/AfghanistanMore serious survivable injuries – needing complex careDifficulty with injured soldiers navigating health care systemModeled 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, 2008Department of Defense TRICARE Management Activity Medical Management Guide Version 3.0DTM , Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health SystemDoDi , Medical ManagementMEDCOM Soldier Medical Readiness CampaignHQDA EXORD , Healing WarriorsMEDCOM OPORD 07-55, MEDCOM Implementation of the Army Medical Action Plan (AMAP)MEDCOM OPORD 11-20, Patient Centered Medical HomeMEDCOM OPORD 10-66, Medical Management CentersComprehensive Transition Plan GuidanceEach 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 MHSUtilization ManagementCase ManagementDisease ManagementIntegration and coordination of servicesQuality, completeness, and adequacy of total health careOutcome Management
7 DTM (July 2012)Interim Guidance for Clinical Case Management for the Wounded, Ill, and Injured Service Member in the Military Health SystemOriginally released Aug 2009All-service and component requirementsBasic education, certification, and trainingPerformance MeasuresDocumentation/CodingTake 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 MMGMilitary Health System Guide to Case Management
10 MEDCOM OPORD 13-25 Nursing Case Management Guidance Consolidation of referencesAcross all components5 lines of effortCM IDTraining/EducationPerformance standardsQuality outcomes/measurementStrategic communicationTake aways:
11 Army National Guard Case Management Goal – Reduce Medically Not Ready population to maximize number of Soldiers available for mobilization/deploymentPHA/SRP/SRC SupportLOD/IDES PreparationRemote CareTelephonic Case ManagementElectronic Database SystemsREFERENCESMobilizationARPPG -USCENTCOM Z DEC 11 MOD ELEVEN TO USCENTCOM INDIVIDUAL PROTECTION AND INDIVIDUAL-UNIT DEPLOYMENT POLICYCommunity ResourcesVHA
12 MEDCOM Soldier Medical Readiness Campaign 2011-2016 Strategic Level Medical Readiness PlanPopulation HealthID, Mgt, Health PromotionPerformance MeasuresCommo
13 MEDCOM OPORD 10-66, Medical Management Centers Closest to what we do at the AC levelManages MNR PopulationCollaboration with UnitsExpands use to the RCWe 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 CMRC based on non-clinical CMOSSG-1SMUNITPCMNCMSMSQD LDR
22 Comprehensive Transition Plan Guidance WTU Action Plan for SoldiersTwo TracksRemain in the ArmyTransition out of the ArmyClosely 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 CareSoldier and Family Assistance Centers (non-medical)FRAGOS1: Administrative changes to staff visits, add more specific tasks to Chiefs of Staff, adjust focus2: SFAC setup3: Refining WTU screening and entrance criteria4: Reserve Component Remote WTU focusOnce 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 MEDCOMTasks RMC’s with AMAP deadlinesStreamlines Soldier and Family transitionSets up TDA and Unit criteriaSome tasks were taken out of the HQDA EXORD and given to subordinate units (MEDCOM)All FRAGOs incorporated into Consolidated documentVERY Specific guidance – includes websites and appendicies
25 MEDCOM OPORD 11-20, Patient Centered Medical Home MHS Primary Care ModelPart of Access to Care Campaign (2008)100% direct care enrollees in a PCMH NLT FY 2015Utilization ManagementBased on NCQA Standards for PCMHNCQA – National Committee for Quality AssuranceIs your Soldier in a Primary Care PCMH? Ask!
26 AR 40-501 Standards of Medical Fitness The BibleAR Standards of Medical Fitness
27 MMPS Each case meeting assures: 1) temp profile updated as warranted Case Manager(CM)-reviews case- assigns toCare Coordinator (CC)MRNCO-assist SM w records/profiles BN monthly report- hand off to CMCC continues to- assist SMCC continues to- assist SM- coordinate wCM/MRNCO asneeded- coordinate wCM/MRNCO asneeded0 MO NLT 3 MO NLT 6 MO NLT 9 MO NLT 12 MOTemp profile written (issue found by self report, PHA, PDHA,PDHRA)Case meeting #1 CMD/SS/G1 and CMCase meeting #2CMD/SS/G1 and CMCase meeting #3CMD/SS/G1 and CMMRDPNot reached MRDP ?May get ONE TIME temp prof extension per SSEvery 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 warranted2) 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 SystemRecording ProceduresThe Physical DisabilityEvaluation SystemA provider determines that a soldier has a medical limiting conditionSoldier meetsRetention StandardsSoldier does not meet Retention StandardsAppropriate profile is issuedAppropriate profile is issuedMedical condition is non-duty relatedMedical condition is duty relatedTemporary Profile is issuedA Permanent 2 Profile is issuedA Permanent 3 Profile is issuedSoldier elects a non-duty PEBSoldier is referred to MEBSoldier recoversSoldier is issued a permanent profilePEB - FitPEB - UnfitSoldier continues with physical disability processingSoldier is referredto MAR2PEB - FitPEB - unfitSoldier is retained in MOSSoldier is retained with a change in MOSSoldier is retained with a trial dutyAppropriate disability is awardedLegendMedical ActionMilitary Personnel ActionActive Component ActionMAR2 – MOS Administrative Retention ReviewMEB – Medical Evaluation BoardPEB – Physical Evaluation BoardSoldier returns to dutySoldier receives Administrative Discharge