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On July 1, 2005, Humana Military launched a new Heart Failure Disease Management Program. This program is available to TRICARE beneficiaries in the South Region who have heart failure and are at risk for further medical complications as a result of this chronic condition.
Humana Military encourages providers to refer patients to this program so they may benefit from the nursing support and expertise it offers.
Primary care managers (PCMs) and military treatment facility (MTF) providers may refer candidates to the program (see “Program Review Criteria ” for details). Web referrals are delivered to a central mailbox that is reviewed on a daily basis.
Acceptance into the program is based on Humana Military’s review of beneficiary claims data (e.g., diagnosis and procedure codes). TRICARE beneficiaries who meet certain diagnosis criteria and who are not entitled to Medicare are eligible for the program.
The program is designed to minimize the impact of having long-term compromised health. According to Rose Mary Royalty, Humana Military’s director of case management, “A beneficiary could benefit greatly from the disease management program because they would have a dedicated registered nurse knowledgeable about complications and treatments of heart failure. The program also supports and complements the MTFs’ and civilian providers’ plan of care through teaching and compliance monitoring.”
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