Medical Management in Today’s TRICARE Environment

The TRICARE Management Activity (TMA), Population Health and Medical Management Division (PHMMD), offers a 4-day onsite classroom-based Medical Management course in an effort to support and advance the education and training of all personnel involved in Medical Management.

The purpose of the course is to provide Military Treatment Facility (MTF) healthcare personnel a comprehensive, educational program, which demonstrates the link between business planning and clinical decision-making under a Medical Management (MM) program.

Target Audience

All MTF healthcare personnel (i.e., nurses, providers, administrators, etc.) involved in Medical Management. Medical Management includes the core components of Utilization Management (UM), Case Management (CM), and Disease Management (DM).

Course Goals

1. To describe the concepts and principles of an effective MM program.
2. To discuss the financial impact of effective MM clinical and business processes within the Direct Care System (DCS).
3. To demonstrate methods of monitoring and evaluating MM processes within the MTF.

Course Objectives

Upon completion of this course, the participants should be able to:

• Identify measurable MM business and/or clinical goals (e.g., referral management); perform appropriate data analysis; and based on the outcomes, provide recommendations for change and/or process improvement.
• Comprehend how to obtain appropriate MM data, which drive the MTFs clinical and business activities by identifying who the data analysts are and which tools and data sources are available tools (i.e., Population Health Portal, TRICARE Operations Center [TOC)]), which support utilization (e.g., specialty referrals), case, and disease management processes.
• Demonstrate clinical and business strategies for monitoring and evaluating MM programs through the use of case study activities.
• Apply methods of data monitoring and analysis to their own MTF’s MM program through the use case study activities.
• Comprehend how MM activities relate to business processes (i.e., financial incentives for the managed care support contractors) and clinical processes (referral management) as it relates to the Direct Care System and Purchase Care System utilization.