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News from MHS (Military Health System
NEWS FROM MILITARY HEALTH SYSTEM
Case Management for the Seriously Ill and Injured Sailor and Marine
Joan McLeod, BSN, MGA, CCM, Commander Cambrai Hardy, USN, NC, BSN, BS, MSHCA, and Lorri Ward, MSN, RN
The United States military healthcare system (MHS) is a one of the largest healthcare delivery systems in the country. It is unique and complex in that it delivers healthcare to approximately 1.3 million active duty service members and another 8.3 million other eligible beneficiaries, while caring for those injured in the battlefield. Service members are given emergency care in battle and medically evacuated by air transport to medical hospitals sometimes hours away. The system also has to meet the mission of the military by ensuring that service members are medically fit and ready to meet their challenging assignments, which can be in remote austere locations, on close quartered ships, submarines, and airplanes. At all the military treatment facilities (MTF), which consists of hospitals and clinics that provide care to MHS beneficiaries, the active duty service members are the priority for access to care. Through the MHS TRICARE program some beneficiaries receive care outside of the military hospitals and clinics through “management care support contractors” with civilian healthcare programs. Managing TRICARE beneficiaries requires some basic knowledge of the TRICARE program.
Familiarization with key components of the MHS case management system specific to the care of the Navy and
Marine Corps active duty population with serious or severe illnesses and injuries is the focus of this article with some basics of the TRICARE program. Each of the Services—Army, Air Force, Navy, Marine Corps, and Coast Guard—have Wounded Warrior medical and nonmedical case management programs specifically designed to address the needs of the most severely wounded, ill, and injured service members.
Medical case managers work with Service-specific nonmedical case managers often known as Recovery Care Coordinators (RCC), providing support to service members who have serious injuries or illnesses that make it unlikely to return to active duty or service members with severe or catastrophic injuries or illnesses, who most likely will be medically retired from the military.
The focus of case management for these cases is on supporting a recovery service member’s rehabilitation and reintegration back to active duty or veteran status. For those whose medical condition is not conducive to continuing service, the focus is on successful transitions of care without gaps in care, coverage of all military benefits, and related services including engagement in health care rendered at nonmilitary, civilian hospitals, or Veterans Affairs facilities. The RCC provide nonmedical support such as assistance with resolving financial, administrative, personnel, and logistical military problems for the service member and families. They assist with finding resources to maintain or improve the service member’s quality of life while preparing them for life outside of the military. They collaborate with Department of Defense and civilian organizations that provide programs for posttraumatic stress disorder/substance use disorder, traumatic brain injury rehabilitation and reintegration, adaptive recreation, and adaptive athletics programs that enhance recovering service members.
An individualized comprehensive
Joan McLeod, BSN, MGA,
CCM, is the Medical Management and Referral Management Program Manager for the Navy Bureau of Medicine and Surgery. Commander Cambrai Hardy, USN, NC, BSN, BS, MSHCA, is the Commander, Navy Installation Command, for the Navy Wounded Warrior Program, Lorri Ward, MSN, RN, is the Regimental Nurse Case Management and Benefits Advisor for the Headquarters Marine Corps Wounded Warrior Regiment.
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