Humana Military’s
Disease Management Program assists TRICARE beneficiaries in the South region who are not Medicare-eligible but have been diagnosed with chronic conditions like asthma, diabetes or heart failure.
Under this program, eligible beneficiaries are identified by the TRICARE Management Activity (TMA), and the program is administered by Humana Military. Beneficiaries are contacted by registered nurses who work with the beneficiary and his or her physician to identify problems and establish goals, and then monitor those goals through regular follow-up care.
John Crum, M.D., Humana Military’s chief medical officer, says “The program’s goal is to improve the patient’s symptoms, functional abilities and overall quality of life by closely monitoring their treatment program and their regular activities. This is a program that has one purpose and one purpose alone—to help patients deal effectively with a very serious medical condition.”
Although patient care is managed by a beneficiary’s primary care manager (PCM), beneficiary eligibility is determined by TMA, not the patient’s PCM or other provider. TMA reviews patient data, weighs it against the program’s criteria and sends referrals of qualified beneficiaries to the TRICARE Regional Office (TRO). The TRO forwards the referrals to Humana Military’s disease management staff.
Rose Mary Royalty, program director for the Disease Management Program, adds, “The role of the disease management nurses is not to interfere with the providers and their treatment, but more to support the providers and intervene on the patient’s behalf.
Nurses conduct thorough assessments to find out what a patient’s needs are. For example, if the patient has asthma and is also a smoker, we will assess the patient’s 'readiness to change’ before setting a goal for the patient to quit smoking. If the patient doesn’t have an asthma action plan, we will provide a template for one. The patient can take the template to his or her physician and together they can develop a plan that is right for the patient.”
Additionally, the program’s registered nurses are available to coach and educate patients about their condition, assist beneficiaries with getting an appointment when urgency is indicated and facilitate finding a specialist, when necessary.
