Case Management: New Paradigms in Warrior Care

1
2008 MHS Conference Caring for Americas Heroes

• Case Management New Paradigms in Warrior Care

2
Who Needs CareWounded, Ill and Injured (WII)
Population
OIF/OEF Military Personnel vs. Civilian Population
Source a Dole-Shalala Commission Report for
military deployed b Department of Health and
Human Services Center for Disease Control and
Prevention c VA National Center for PTSD d
http//www.amputee-coalition.org/fact_sheets/limbl
oss_us.html e Department of Health and Human
Services Center for Disease Control and
Prevention f Department of Health and Human
Services Center for Disease Control, National
Center for Injury Prevention and Control g
http//www.eyecenter.emory.edu/pr_retina_14.htm h
Medical Surveillance Monthly Report, vol. 14,
no.7, Armed Forces Surveillance Center, 2005 OIF
data
1
3
How is Care Provided Now?
4
2
4
Who Provides What Care/Services Now?
Providers
Services
3
5
How Care Can be Reformed

• Vision
• Provide integrated continuity of world-class
  quality care and service delivery for wounded,
  injured, ill service members and their families
  throughout the continuum of care from recovery
  and rehabilitation to reintegration
• Scope
• Inter-service, interagency, intergovernmental,
  public and private collaboration through unified
  common standards of care, standards of practice
  across the vertical and horizontal continuum of
  case management service delivery
• Key Players
• DoD (e.g. Medical, Service Injured Programs,
  Family Support, PEBLOS, Chaplains), VA (e.g. VBA,
  VHA, TPAs), DOL, Ed, HUD, HHS, State Agencies,
  VSOs, VBOs, Associations, CBOs, Academia and
  Private Sector
• Testimony to Dole/Shalala Commission (May 07)

4
6
A Partnership for Case/Care Management
Intergovernmental
Interservice
Interagency
Education Training, Employment Service
Administrative, DES, Benefits, Pay/Personnel
Case/Care Management
WII Member Family
Community Reintegration
Recovery, Rehabilitation
Medical Rehabilitative Care
WII Family Support Services
Private
Public
5
7
Studies of the Care of the WII
Task Force on Returning Global War on Terror
Heroes
Mar 07 - Apr 07
Independent Review Group (IRG)
DoD IG Review of DoD/VA Interagency Care
Transition
Feb 07 - Apr 07
Aug. 2006 June 2007
Commission on Care for Americas Returning
Wounded Warriors
Mar 07 July 07
Mental Health Task Force
May 06 June 07
Veterans Disability Benefits Commission (www.vet
scommission.org)
2004 Oct. 2007
6
8
The Call for Change in Care for WII

• We dont recommend merely patching the system,
  as has been done in the past. Instead, the
  experiences of these young men and women have
  highlighted the need for fundamental changes in
  care management
• Source Report of the Presidents Commission on
  Care for Americas Returning Wounded Warriors
  (Dole/Shalala) July 2007

7
9
DOD/VA Response to Reform Care

• DOD/VA created the joint Senior Oversight
  Committee (SOC) in May 07 to make reforms and
  implement the studies recommendations
• Lines of Action (LOAs) were established to
  improve the disability evaluation system,
  treatment for special diagnosis (e.g., TBI, PTSD,
  PH), data sharing, case/care management,
  facilities and pay/personnel issues

8
10
Senior Oversight Committee Structure
Senior Oversight Committee (SOC) Co-Chairs DEPSEC
DEF and DEPSECVA
Incoming from other commissions
Overarching Integrated Product Team (OIPT)
Full-time staff and VA Detail
Press Releases
Winter Runnels
Carr Pamperin Feeley
Embrey Sigford
Davis Day
SJones Tibbits
Grone Neary
McGinn Hill
Dominguez Cooper
1
2
3
4
5
6
7
8
Personnel, Pay Financial Support
Disability System
TBI/PTSD
Case Management
DoD/VA Data Sharing
Facilities
Clean Sheet Design
Legislation Public Affairs
9
11
LOA 3 Case/Care Management Reform

• Created the Federal Recovery Coordination Program
  (FRCP)
• Views case/care management as a process for
  quality assurance and improved resource
  allocation for all WII service members, veterans
  and their families through
• Federal Recovery Coordinator (FRC)
• Federal Individual Recovery Plan (FIRP)
• Multi-Disciplinary Team and Partner collaboration
• National Resource Directory
• Family Handbook
• My E Benefits
• Evaluation (Continuous Process Improvement,
  Evidence Based Care, Best Practice
  Dissemination, Systems Redesign)

10
12
FRCP Federal Recovery Coordinator

• Federal Recovery Coordinator (FRC) is the WII,
  service members, veterans and families ultimate
  resource to oversee the development and
  implementation of services through the FIRP
  across the continuum of care from recovery
  through rehabilitation to reintegration in
  coordination with relevant governmental, private
  and non-profit programs
• FRC monitors and regularly modifies the FIRP in
  conjunction with the multiple, Multi-Disciplinary
  Teams (MDTs), to reflect the WII and family
  requirements for services

11
13
Federal Recovery Coordinators in MTFs

• Phase I November 2007 through April 2008
• Hire/Train/Place 10 FRCs at 4 MTFs starting Jan
  08
• Current Status
• 3 FRCs at Walter Reed Army Medical Center
• 2 FRCs at Brooke Army Medical Center
• 3 FRCs at National Naval Medical Center
• Future Intent
• 1 FRC at Brooke Army Medical Center
• 1 FRC at Naval Medical Center San Diego

12
14
FRCP Federal Individual Recovery Plan

• Federal Individual Recovery Plan (FIRP), provides
  an individualized, integrated, longitudinal,
  clinical/non-clinical service plan across the
  continuum of care for WII service members,
  veterans and their families
• Veterans Tracking Application (VTA) prototype
  (Feb-Jul)
• FIRP beta test (Aug-Dec)
• Integrated with JECs information sharing and
  technology goals and Medical Records Working Group

13
15
FRCP National Resource Directory

• National Resource Directory is an interservice,
  interagency, intergovernmental, public/private
  and non-profit resources for use by the FRC, the
  multiple MDTs, and the WII service members,
  veterans and their families
• Partnership with DOD, VA, DoL
• Based on DisabilityInfo.gov portal
• Content managed by stakeholder/partner
• Prototype for FRCs April
• Prototype for MDTs May
• DoD/VA public rollout - August

14
16
FRCP Criteria for Population to be Served

• Criteria for WII enrollment
• MTF-based interdisciplinary team will review
  following criteria, within three working days
  post-admission, for assignment of WII, veterans
  and families to FRCP during Phase 1
• In acute care at MTF
• Diagnosis of Spinal Cord Injury, Burn,
  Amputation, Visual Impairment, TBI/PTSD
• At risk because of psychosocial complications
  (psychosocial and family assessment)
• Patient self referral based on ability to benefit
• Command referral based on ability to benefit
• All AC and RC eligible for enrollment in FRCP

15
17
FRCP Reformed Case/Care Management Process
Recovery MTFs VAMC Private Facilities Military
Service Command, Clinical and Non Clinical
Multidisciplinary Team WII and Family Centered
Federal Individual Recovery Plan (FIRP)
Developed with Multidisciplinary Team Federal
Recovery Coordinator oversees FIRP
Rehabilitation Return to Duty Military Service
Tracks Federal Recovery Coordinator modifies
FIRP
Fit
Theatre System of Care

• Reintegration
• Civilian Life
• Education, Training
• Employment Services
• Family Support
• VA Supports
• TPA Assigned Military Service Tracks
• Federal Recovery Coordinator modifies/oversees
  FIRP

Medically Retired VA Supports TPA Assigned
Military Service Tracks Federal Recovery
Coordinator modifies/oversees FIRP
Not Fit
DOD Clinical/Non-Clinical Interdisciplinary Team
Input and Service for FIRP
VA Clinical/Non-Clinical Interdisciplinary Team
Input and Service for FIRP
Federal Recovery Coordinator Oversees Federal
Individual Recovery Plan
Federal Individual Recovery Plan, My E-Benefits,
Resource Directory, Family Handbook
HHS/PHS Support Federal Recovery Coordination
Program
16
18
Context of FRCP Reform Implementation
Environment
Organization
Care Team
WII Family
FRC, CCM, NCCM, MTDs
Infrastructure, Resources (MTF, VAMCs, TRICARE,
all partners)
American public, elected officials,
policy, legislation, regulations
The FRCP will support the WII, veteran, family
with transitions across the continuum of care,
the care teams, organizations and environment.
17
19
Allies in Case/Care Management Reform

• National Transitions on Care Coalition and Case
  Management Society of America
• Promoting the value of case management to elected
  officials, legislators, employers, regulators,
  and the consumer
• Health and Human Services
• Medicare Health Coaching, a pilot case management
  program designed to counsel recently hospitalized
  patients
• Federal Emergency Management Association and
  Housing and Urban Development
• Working together to provide case management
  services to those still displaced by Hurricanes
  Katrina and Rita
• Institute of Medicine
• Collaborating with National Academy of
  Engineering to address systemic reforms in TBI
  care that is safe, effective, patient-centered,
  timely, efficient and equitable

18
20
End State Transforming Case Management into
Care Management

• "Optimally, case management assists and guides
  patients in a collaborative process, using a
  defined plan to meet the individuals health
  needs. It can include both clinical and
  non-clinical components. The concept is an
  important one - coordination of care"
• Integrated care management provides patients
  with the right care and benefits at the right
  time in the right place by leveraging all
  resources appropriate to the needs
• Source Report of the Presidents Commission on
  Care for Americas Returning Wounded Warriors
  (Dole/Shalala) July 2007

19