Porter and Flagg Presentation

Transcription

Biography
• Seth Y. Flagg MD
– Dr. Flagg is a board certified family medicine
physician and dive medical officer currently
serving as the USMC Wounded Warrior
Regimental Surgeon.
– He is an Assistant Professor of Emergency
and Military Medicine at the Uniformed
Services University of Health Sciences. He
has conducted research on multiple grants
and has multiple publications.
– He is a national leader in medicine having
served on the Board of Directors for the
American Academy of Family Physicians and
in multiple national leadership roles in the
American Medical Association.
Wounded Warrior Call Center 24/7: 1.877.487.6299 -- Stay Connected -- www.woundedwarriorregiment.org
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Biography
• Dustin M. Porter MD
– Dr. Porter is a board certified family medicine
physician that was most recently stationed
aboard the USS GEORGE WASHINGTON
(CVN-73) and now is stationed at the United
States Marine Corps Wounded Warrior
Regiment.
– He is the Deputy Regimental Surgeon and the
Senior Medical Officer for the Reserve
Medical Entitlements Determination Section,
which is the benefits issuing authority for the
Commandant of the Marine Corps.
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Defense Centers of Excellence for Psychological
Health and Traumatic Brain Injury Summit:
Continuum of Care and Care Transitions in the Military Health
System
Defense Health Headquarters
Falls Church, Virginia
10 September 2015
Presenters
Unique Opportunity To Bridge Medical Case Management
And Benefits Issuance In The Marine Corps Reserves
Seth Y. Flagg MD (LCDR MC(UMO/DMO) USN)
Family Medicine Physician
Regimental Surgeon
Wounded Warrior Regiment
Headquarters Marine Corps
Dustin M. Porter MD (LCDR MC(SW) USN)
Family Medicine Physician
Deputy Regimental Surgeon
Senior Medical Officer
Reserve Medical Entitlements Determination Section
Wounded Warrior Regiment
4
Disclosure
 The views expressed in this presentation are those of the presenters
and do not reflect the official policy of the Department of Defense,
United States Marine Corps, or the U.S. Government.
─ LCDR Porter and LCDR Flagg have no relevant financial relationships to
disclose.
─ LCDR Porter and LCDR Flagg do not intend to discuss off-label/investigative
(unapproved) use of commercial products or devices.
─ LCDR Porter and LCDR Flagg are obligated to disclose any products or
procedures which are off-label, unlabeled, experimental, and/or investigative (not
FDA approved) and any limitations on the information that is present, such as
data that are preliminary or that represent ongoing research, interim analyses,
and/or unsupported opinion.
─ The description of programs in this presentation is for descriptive purposes only
and not intended to promote any individual program
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Learning Objectives
• Explain the process by which the Marine Corps
Wounded Warrior Regiment (WWR) and RMED assists
reserve Marines with bridging the gaps of medical care
within their communities.
• Discuss process integration between the nonmedical
Benefits issuing Authority and WWR MedCell (medical
case management/care coordination).
• Discuss best practices on process integration that could
be adopted or modified by other Services or programs.
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Challenges facing WII Marines
• Wounded Ill and Injured (WII) Marine Reservists typically
face unique challenges to their recovery to include
–
–
–
–
Distance from Military Treatment Facilities (MTF)
Reserve specific administrative processes
Differing levels of benefits
Lack of knowledge in both medical and non-medical communities
require unique interventions
• These challenges can result in WII Reservists not
receiving the care that they need to return to a deployable
status.
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The identifying the problem
During fall of 2014 a review of all Reserve Medical
Entitlement cases showed 15% of caseload (70 out of
470), were failing to make progress in their recovery.
Multiple gaps were identified both within the treatment
plans and the utilization of medical Reserve Marine
benefits.
Due to limitations in the authority and scope of RMED
was unable to fully address these gaps in care.
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The Solution
Creation of partnership between:
-MedCell of USMC Wound Warrior Regiment
-RMED
Focused leveraging assets of both
organizations to address gaps in WII
Reservist Care.
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Reserve Medical Entitlements
Determination (RMED) SECTION –
Program Manager- Mark Brokaw SgtMaj Ret.
SNCOIC- GySgt Maria Lee
SMO- LCDR Dustin Porter
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- RMED is the Benefits Issuing Authority for Headquarters
Marine Corps with respect to all medical benefits for the
reserve Marines that are wounded, ill, and injured.
- The Office is equivalent to other services Separations
and Retirements branch within Manpower Management.
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Governance
MedHold ReferencesMARADMIN 257/03
MARADMIN 259/04
MARADMIN 472/09
Manual of the Med Dept (Chap 18)
MCO P1900.16F (Chap 8)
MCO 6320.2E (Hospitalized
Marines)
MCO 1770.2A – Revision being sent
to RA for review
IDES ReferenceSECNAV 1850.4E
LOD References10 U.S.C. Sect 1074 Chapter 55
Defines all benefits to medical and
dental care for Reservists
37 U.S.C. Sect 204
Defines benefit to incapacitation pay
for injured Reservists
DoD Directive 1241.1
Establishes policy, assigns
responsibilities, and prescribes
procedures on entitlement to medical
treatment and incapacitation pay to
members of the Reserve
components of all services.
DoD Instruction 1241.2
More precisely defines policy,
responsibilities, and procedures of
DoD Directive 1241.1
SECNAVINST 1770.3D
The Navy’s LOD order
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RMED Programs
• Medical Hold Program
− Reservists on AD > 30 days who must
be retained beyond their EAS / ECC for
medical treatment.
− Reservists on AD for less than 30 days
who are admitted for inpatient treatment
(MedHold for inpatient period only).
Learn more about RMED. Locate our Support
to Wounded / Ill / Injured Reserve Personnel at:
http://www.woundedwarriorregiment.org/index.c
fm/aboutus/factsheets/
• Line of Duty (LOD) Benefit
(previously known as “Notice of
Eligibility;” Does not mean LOD
Investigation is required)
− Reservists injured at drill weekend,
annual training or on active duty 30
days or less.
− Reservists on AD >30 days who
demobilize, but need care for ailments
caused or directly aggravated by
military service.
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USMC Reserve /RMED Case Flow Diagram
Marine
Identifies
medical
Condition
Unit submits
case in
MCMEDS
RMED
reviews the
case
Medic
Review
Team
Treatment
Authorized
Benefits are
awarded to
the Member
Admin
Review
Team
Final RMED
Approval/BIA
Return to full
Duty
Continual
Review by
RMED
Process
through the
IDES
No Healthcare =
No return to duty
Treatment is
never
initiated
90
Days
Suspension
30
Days
Termination
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• Consequences – Suspension of the cases after 90 days of noncompliance
– Certified mail letter sent to the service member
– Termination of cases after another 30 days
– Many service members within the reserve component
are injured or ill and are not receiving the care that
they need to return to a deployable status.
15
Wounded Warrior Regiment Mission
Provides leadership and facilitates the integration of non-medical
and medical care to combat and non-combat wounded, ill, and
injured (WII) Marines, sailors attached to Marine units, and their
family members in order to maximize their recovery as they return
to duty or transition to civilian life.
• Serves the total force – active duty, reserve, retired, and veteran Marines.
• The only official Marine Corps unit charged with providing non-medical care
to WII Marines.
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Global Reach
Wounded Warrior Regiment support is not a factor of luck and location.
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WWR Medical Mission: Bridging the Gap
The Medical Cell bridges the gap between non-medical and medical experts by
assisting with locating and connecting appropriate points of contact and ensuring
a shared vision of recovery between all members of the care team.
Once high quality and communications is established by Medical and Non-Medical,
Medical Cell will suspend case to avoid redundancy. If further assistance needed
Medical Cell will re-engage upon request.
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WWR (MedCell)
The MedCell:
 Unique partnership between USMC & Navy Medicine
where specialized medical staff are embedded in USMC
unit (Wounded Warrior Regiment) and funded by BUMED
(Project 95#)
 Coordinates comprehensive health care access and
treatment options for WII with emphasis on Psychological
Health, Traumatic Brain Injury and emerging therapies
 Works closely with clinicians/case managers at Navy
Bureau of Medicine and Surgery (BUMED), MTFs, VA and
civilian facilities
 Provides advocacy, education and expertise in military
health issues and resources
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WWR MEDCELL OUTCOME MEASURES
New Patient Referrals:
Active Duty:
Veteran:
Reservists:
42
14
15
13
TOTAL MEDCELL CONTACT TO-DATE: 8,285
Week of 3-7 August 2015
*Slide is now capturing numbers from Reserve Case Management Monitor
Patient Total
Risk Variables
Homeless
0%
Family Issues
4%
Total
Legal Issues
4%
AD
VET
RES
129
Unemployed
9%
63
42
14
48
18
13
August
Barriers to
Care
18%
Med. Illness
34%
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July
Open/Suspended Cases
1400
1200
1000
800
Medical
Records
11%
Financial
Needs
14%
Substance
Abuse
3%
Command
Issues
3%
600
1172
Opened
879
Suspended
400
Active
200
293
0
Cases
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WWR Support for Reserve Marines
• Liaison Officer (LNO)- provides liaison between WWR and MARFORRES
staff in matters related to care and support of Active and Reserve WII
Marines / families.
 Keeps WWR informed of issues impacting care of Wounded Ill and Injured
(WII) Reserve Marines.
 Works with MARFORRES leadership to facilitate training of commands on
administration and personal attention required for hospitalized as well as WII
Marines.
 Assists Reserve Medical Entitlements Determination (RMED) Section in
ensuring MARFORRES units are following proper procedures for Line of
Duty (LOD) and Medical Hold (MEDHOLD) benefits as well as limited duty
(LIMDU) and medical board (IDES) processes.
 MFR LNO is collocated with MARFORRES G-1 in order to work directly with
MFR Manpower Staff and liaise with major subordinate commands.
21
WWR Support for Reserve Marines
• District Injured Support Coordinators (DISCs) are the
Marine Corps’ representatives in the civilian
community. They are aligned with the Department of
Veterans Affairs Veterans Integrated Service
Network. DISCs provide a multitude of services to
include:
Conducting face-to-face visits with Marines and families
Ensuring Marines are registered with their regional VA
Providing information on various community resources
Linking WII Marines in need back to the WWR for assistance
22
Partnership RMED and WWR MEDCELL
• The RMED/ WWR MedCell Partnership focused
on the following to over come the challenges
facing WII Marine Reservists
–
–
–
–
Nursing Case Management integration
Case Review
Outreach
Follow up
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The solution:
WWR MedCell staff, a Care Management Monitor (CMM), had
previously been imbedded in the RMED section with specialization in
conventional nursing case management.
Under the Direction of the RMED SMO, case management was
integrated directly with the, completely administrative, Benefits Issuing
Authority (BIA). This leveraged the care resources of the
WWR(Recovery Care Coordinators, subject matter experts in IDES,
Pay and entitlements, SCAADL and TSGLI), Military Medicine and the
VA while ensuring strong administrative oversight.
This team also conducts near weekly comprehensive review of all
cases in the Suspended and Pending Termination status. Keys gaps
(medical and non-medical) in care were identified.
We are actively engaging the units along with the WII Marines to get
these cases online through outreach and education.
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• Over a six month period we were able to
show significant decreases in the number
of delinquent cases across our enterprise.
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The Math
From January to June we were able to reduce the
average number of suspended cases from 35 to
13 which is a 63% decrease.
In the same time frame we were able to decrease
the number of cases pending termination from 34
to 23 which is a 33% decrease.
26
Next Steps
• Move to more proactive model.
– Expand partnership with focus on early
identification of Reserve cases that are at risk
for non-progression sooner
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Discussion
• How could you mold this model to fit your
program?
• Suggestions for us!!!
28
How To Obtain CE Credit
To receive continuing education credit
for this activity, please visit:
http://dcoe.cds.pesgce.com to
complete the CE evaluation and posttest. You must register by 11:59 p.m.
(PT) on Sept. 11, 2015, to qualify for
the receipt of CE credit.
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Porter and Flagg Presentation

Transcription

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