Medical Management

Medical Management

Medical Management (MM) program is multidisciplinary care team who communicates, documents, coordinate processes, and promote seamless care transitions and reduce fragmentation of MM activities across varied treatment settings to include direct care, purchased care and Department of Veterans Affairs (VA)

Subjects

Case Management

Why Would I need Case Management?

The need for Case Management services is determined through a collaboration between you, your family or caregiver, your health care team, and our provider. This collaboration will include a comprehensive assessment of your health, psycho-social needs, and use of health care series and resources.

Case Management can help by:

  • Coordinating your care
  • Assessing, planning and facilitating services for you
  • Evaluating your options
  • Advocating on your behalf

You or your family member may need case management if you have:

  • Instability with chronic health problems
  • A serious terminal illness
  • An increased need for different provider specialties due to multiple diseases or conditions
  • A need for more support and education during a critical period

Who are Case Managers?

Case Managers are usually nurses or social workers who can help you and your family figure out complex health care and support systems. They will work with you to coordinate the services and other community resources you need.

They can help:

  • Provide advocacy, support and education
  • Reduce burden and streamline appropriate utilization of care
  • Partner with members of your healthcare team to assist in coordination of your healthcare needs
  • Monitoring for progress and desired outcomes

Who to contact

  • Address:
    US Naval Hospital Yokosuka Case Management Clinic, Room 1C71,
    1-Chome, HONCHO, Yokosuka, Kanagawa, 238-0041, Japan
  • DSN: 315-243-4614/8629
  • Comm: 011-81-46-816-4614/8629
  • Email: usn.yokosuka.navhospyokosukaja.list.medical-management@mail.mil
  • Hours of Operations: 0700-1600 Monday thru Friday, except on all Federal Holidays

Disease Management

Population identification processes for at-risk populations and patients who should benefit from disease-specific education. This is accomplished through proactive collaboration with patient and healthcare teams and utilization of predictive analytics.

  • Managing Population Health initiatives to improve patient outcomes
  • Identification, tracking, and reporting on top medical diagnosis and Healthcare Effectiveness Data Information Sets (HEDIS) metrics trends
  • Reduced practice variation and improved care through evidence-base DoD/VA clinical practice guidelines.
  • Provide information and tools to promote patient-self management activities and education to enhance shared decision-making skills

Disease Management tracks the following

  • Cancer screening
  • Chlamydia Screening
  • Acute Bronchitis (adults)
  • Diabetes
  • Low Back Pain
  • Pediatric (pharyngitis, upper respiratory infection, well child visit)
  • Mental Health (depression, on medication, follow-up visits at 7 days and 30 days on discharge

Who to contact

  • Address:
    US Naval Hospital Yokosuka Disease Management Clinic, Building E22, Room 205
    1-Chome, HONCHO, Yokosuka, Kanagawa, 238-0041, Japan
  • DSN: 315-243-3289
  • Comm: 011-81-46-816-3289
  • Email: usn.yokosuka.navhospyokosukaja.list.medical-management@mail.mil
  • Hours of Operations: 0700-1600 Monday thru Friday, except on all Federal Holidays

Utilization Management

Utilization Management is a process that ensures client/support systems receive needed care and services in the necessary care setting by the appropriate care provider. Utilization Management applies across the continuum of health and human services. It manages and evaluates healthcare resources used to meet the requirements of the applicable health benefit plan in providing the highest quality in the most cost-effective and efficient care setting. The areas of focus are clinical care, reimbursement, denials, transition of care, and evaluation.

Utilization Management Evaluates

  • The medical necessity for services to be provided, including the level of case used
  • The appropriateness of services rendered based on the applicable health benefits plan
  • The efficiency of healthcare services used (e.g., interventions, treatments, test, procedures)
  • The relevance of the healthcare organization and/or provider to the services rendered
  • Risk stratification to identify high-utilizers, high-risk readmissions, and areas of high cost
  • Resource management (e.g., recapture care, continuity of care, pharmacy utilization, high-utilizers)
  • Interdisciplinary collaborations (e.g. direct and purchased care)
  • Prospective, concurrent, and retrospective utilization reviews/quality management
  • Oversight of in-patient discharge planning function
  • Performance and outcome measure reporting (e.g., variance tracking, trending)

Benefits of Utilization Management

Utilization Management department obligation is to you and to the organization. The UM team will coordinate your services, reduce unnecessary costs, and facilitate transitions of care while balancing your needs within the limits of available benefits (coverage) and community resources. The UM team ensures that the care you receive is of high quality, efficient, and cost-effective.

Who to contact

  • Address:
    US Naval Hospital Yokosuka Disease Management Clinic, Room 1C77
    1-Chome, HONCHO, Yokosuka, Kanagawa, 238-0041, Japan
  • DSN: 315-243-8629
  • Comm: 011-81-46-816-8629
  • Email: usn.yokosuka.navhospyokosukaja.list.medical-management@mail.mil
  • Hours of Operations: 0700-1600 Monday thru Friday, except on all Federal Holidays

Pain & Symptom Management

Japanese medical staff do not usually order pain medications to be administered around the clock. It is best for you to communicate with the nursing staff and request medication regularly rather than wait for it to be brought to you. Similarly, you should communicate any concerning symptoms with the medical or nursing staff.

Medications

If you are currently taking medications, inform your physician immediately. If possible, bring them with you to the hospital for review by the physician, as there could be adverse reactions with other medications that may have been ordered. Some U.S. prescribed medications are not authorized in Japanese medical facilities and will need to be returned to your home.

On some occasions, you may be given medication to take throughout the day. If you are unsure of the medication that you are receiving, or how and when to take it, ask the hospital staff or the Case Manager. Be sure to inform the physician and/or staff about any allergies (i.e., medication, food, latex, environmental).

General Information

VISITORS: Children under 12 years of age are not allowed on most wards. Visiting children must be supervised at all times (i.e., no jumping on beds, tables or chairs, no running in the hallways). The patient should not have more than two visitors at a time. Visitors should not use the patient’s toilet. Each host nation facility has varied and restricted visiting hours. In some cases, visitors are restricted to family members only. The Case Manager can help you identify the specific visiting rules for the specific Host Nation facility.

If you have a child that is an inpatient, it is understandable that you will want to stay with your child, unfortunately in most hospitals, there are visiting hours for parents as well. Please remember your child is in good care. We have Japanese Fellows (Doctors) that work for USNH and are following the care of your child, if Tricare Prime or referred by our hospital. They keep Case Management updated daily. If your child was transferred on the weekend they will update the on-call duty provider. You can request an update from the Fellow or Case Manager and they will ensure the on-call duty provider will give you updates if there are any changes.

TELEPHONES: Some hospitals have telephones in the patient rooms; however, these phones only receive calls. Please take your personal cell phone to call your family and friends, along with a charger for 220 volts.

PARKING: Parking is challenging at the hospitals, however, most are within a short walk from USNH. If further, TRICARE family members may accompany Case Management during visits to the patient. Parking tickets are sold in increments of one hour, half-day, or full-day. Some hospitals do not have public parking.


SMOKING: There is no smoking.

PATIENT CONFIDENTIALITY: Host Nation providers have strict confidentiality rules similar to U.S. privacy laws. Only physicians are allowed to give you medical information. They will allow your Patient Liaison to assist and translate, and understand they are bound by the same patient confidentiality rules. Please understand that the Case Managers or Patient Liaisons are not allowed to give any medical

Other Information:

What to bring with you

  • Pajamas / Robe
  • Slippers
  • Underwear
  • Cup / Mug
  • Fork / Spoon
  • Toothbrush / Toothpaste
  • Soap
  • Shampoo
  • Sanitary Pads / Diapers
  • Box of Tissues
  • Razor
  • Wash cloths
  • Yen (1000-2000)
  • Memo pad and pen
  • Personal electronics and reading materials (e.g., laptop, iPad). (Please use ear-phones at all times when using these devises. Don't forget charging cords)
  • Pillow (small firm pillow provided)
  • Mobile phone (please note there will be specific rules about cell phone use)

A refrigerator and TV set are often available in your room for you to use for an additional fee. You may need to purchase a 1000 Yen card at the vending machine located on the ward in order to use the television. The duration of the card is dependent upon usage. If you have credit remaining on the card at the time of your discharge, a refund is available.

Please note:Wi-Fi is typically not offered in most facilities.

Cellular phones must be turned off in Japanese hospitals.

The hospital provides in-patients a lounge (day-room) where you can use your cell phone. Additionally, there are pay phones available for use with Yen or phone card. If the hospital allows use of your cell phone, keep calls to a minimum.

Each hospital has a store that sells food (Japanese style meals, sandwiches, snacks, etc.), drinks (water, coffee, tea, etc.), and other items such as underwear, sanitary pads, towels, slippers, facial tissue, etc. Be sure to check with the nursing staff prior to leaving the ward.

Hospital restaurant: For visiting family members. Large Japanese hospitals often have a restaurant where not only Japanese style meals but also Western style meals are available for purchase. Patients will be provided meals based on doctor's orders. Please discuss dietary concerns with provider.

What You Can Expect

The first thing to remember is that you are in an excellent medical system under the care of a credentialed physician. If the host nation facility and the military treatment facility (MTF) agree your care can be completed at the MTF, transfer arrangements will be made. Japanese health care is in many ways the same as the American system you are accustomed to and in other ways it can be vastly different.

Unlike most hospitals in the United States, the number of Japanese facilities that provide private rooms is very limited and are saved for medical indication. Most rooms do not possess the same modern cosmetic appeal as a private hospital but they contain modern medical technology and provide the same medical treatment capabilities that would be afforded in similar size American hospitals or the military treatment facility.

Some things to keep in mind during your stay:

Patients/parents are encouraged to ask doctors and nurses about their treatment plan. If in the Yokosuka area, your case manager will visit within one to two business days for updates on your plan. If outside the Yokosuka Area TRICARE ISOS will receive daily updates from the Host Nation facility.

Visiting hours are set per the hospital and adhered to as most rooms are shared with other patients. If you are in the Intensive Care Unit, visiting hours are strict and are meant for family members only. They understand that in most instances you are here without family and will sometimes allow a limited few visitors and may ask you to step off the ward to visit if able.

Most Japanese hospitals serve Japanese style meals. If you are unable to tolerate these foods, ask your Japanese physician or a nurse if a family member or a friend may bring in more familiar dishes.

Bring, or have your visitor bring, some Yen to purchase snacks, drinks, and for parking fees as you should not expect to be served American food during your hospitalization.

Very few of the staff may understand English or speak English. Although you may not speak Japanese, a Ohayo gozaimasu (good morning), Konnichiwa (hello/good day), Kudasai (please), Arigatou gozaimasu (thank you) go a long way!

Should TRICARE beneficiaries disagree with their treatment plan, they may sign an Against Medical Advice (AMA) form. However, the patient should be advised that the Host Nation facility cannot be held responsible for medical problems/conditions complicated by the refusal of medical treatment. Active Duty Service Members are not allowed to sign an AMA form. Please keep in mind that you were transferred to the HN Hospital as the care you need is beyond USNH capabilities.

Japanese pay for a lifetime of health care via their taxes. We continue to work hard to build and maintain our excellent relationship with our host nation medical facilities. Without their support, we will not be able to continue obtaining necessary medical services for our beneficiaries when services are not available within our facility. Therefore, we ask that you serve as our ambassador.

Managed Care & Referral Network:

TRICARE Overseas Program (TOP) Prime and TRICARE Overseas Program (TOP) Prime Remote:

TOP Prime and TOP Prime Remote Active Duty Service Members (ADSMs) and Active Duty Family Members (ADFMs) have no out-of-pocket costs when getting covered health care services from your military hospital or military clinic Primary Care Manager (PCM) or when you have the appropriate referral and prior authorization for other care from network or participating purchased care sector providers.

To find a network provider, visit: http://www.tricare-overseas.com/beneficiaries/resources/provider-search

When seeing non-network, nonparticipating providers for covered health care services, expect to pay the full cost of care up front and file a claim for reimbursement. Overseas, there may be no limit to the amount that non-network, nonparticipating providers may bill, and you are responsible for paying any amount that exceeds the TRICARE-allowable charge.

The point-of-service (POS) option allows those using TOP Prime (except ADSMs) to pay additional out-of-pocket costs to get non-emergency health care services from any TRICARE-authorized provider without a referral. Out-of-pocket expenses you pay under the POS option are not applied to your yearly catastrophic cap. For more information about the POS option, go to www.tricare.mil/pointofservice

ADSMs require prior authorization for all inpatient and outpatient specialty care services.

Several of our Referral Management personnel also serve as Patient Liaisons. In this role, they help coordinate network appointments and inpatient admissions, after-hours patient transfers and admissions, translation services for network care, and consult results from network providers.

TOP Prime and TOP Prime Remote Active Duty Family Members (ADFMs):

ADFMs require prior authorization for all inpatient and outpatient specialty care services. ADFMs require prior authorization for outpatient mental health care visits or psychotherapy (this includes outpatient visits for substance use disorder (SUD)). Exceptions apply for psychoanalysis, electroconvulsive treatment and Transcranial Magnetic Stimulation (TMS) services.

International SOS has oversight and is responsible to the patients enrolled in TOP Prime Remote and TRICARE Select for claim processing. International SOS can be contacted on these following numbers: TRICARE Pacific Area: 81-98-970-4854 / DNS 315-645-4854 / From US 1-888-777-8343 or visit http://www.TRICARE-overseas.com.

Non-Enrolled TRICARE Patients with a Referral from a USNH Provider:
The RMC offers referral management assistance to patients who are NOT enrolled to USNH Japan as a TRICARE Prime patient if your referral originated from a USHN hospital. If you are not enrolled to TRICARE Overseas Program Prime Remote (TOP Prime Remote), TRICARE Select or utilize insurance benefits that are not part of the TRICARE program, and have a referral from a primary care provider, the RMC will assist with booking your appointment to one of the local providers. We can provide transportation and translation services to the first appointment only on a space available basis. All proceeding appointment transportation and translation services must be arranged and funded by the patient.

All other patients who are allowed care by USNH Yokosuka (e.g., NATO personnel, DoD affiliates, DoDs teachers) are not bound to providers in the TRICARE network maintained by International SOS.

For all patient categories, if the initial referral was generated by USNH Yokosuka, we will provide the follow up written translation services pertaining to the care you received in the network. Once the written translation is completed the original documentation will be scanned and placed into AHLTA your electronic health record.

Please Note: RMC staff does not contact, provide booking or transportation to providers outside the ISOS network. If the patient seeks care outside the International SOS network, it is the patient's responsibility to seek written translation services.

Medical Bills

If you are enrolled in TRICARE Prime, all necessary medical cost incurred during your Japanese hospitalization will be paid for by your TRICARE benefit. (Note: TRICARE Prime does not cover extra charges for the use of television, refrigerator or private room unless it is medically necessary). You may also be asked to purchase some personal items such as diapers, towels, support stockings, etc. at the hospital store at your own cost. Health Benefits Advisor can be contacted at 046-816-8992.

TRICARE will not cover birth certificates or death certificates

If you have TRICARE Select or other medical insurance, please be aware that Japanese hospitals are not able to bill your insurance companies directly. You as a patient must pay the entire medical bill to Japanese hospital in Yen at the time of discharge or soon after. You must then file a claim with your insurance company for reimbursement. Credit card payment is possible only at some hospitals. Most Japanese hospitals will only accept cash payments in Japanese Yen. When you make your payment, please make sure to receive an itemized receipt as it is necessary when you file a claim with your insurance company.

If you have an extensive procedure or are hospitalized for a long period, your bill may be quite large. Please consult the billing department at the Japanese hospital and your insurance company for assistance in making arrangements to pay the bill. Many hospitals will work with you to arrange a payment plan until you receive the reimbursement from your insurance company.

Some U.S. based insurance companies have Japanese agents who help arrange payments directly with Japanese hospitals. Please contact your insurance representative to verify your benefits and obtain information about the possible use of such agents to help with your bill.

If you have questions or concerns, please contact USNH Health Benefits Office for more information at 046-816-8992 (DSN 243-8992).

Traveling Beneficiaries

Are you planning to travel from your enrolled overseas region to another overseas location? Or, back to the United States? If so, there is important information you need to know about using your TRICARE program options while traveling. For more information, visit:
http://www.tricare-overseas.com/beneficiaries/resources/traveling-beneficiaries

Birth Certificates for Newborns

When a baby was born at a Japanese hospital, his or her birth has to be reported to a Japanese City Hall.

Pre-submission:

You will receive your baby's birth certificated from the Japanese hospital. Only right side of the certificate is filled by the hospital personnel. The left side is left blank for the parents to fill in. The form has to be filled in Japanese. If you do not have anyone to fill the form for you, a case manager can assist you to complete the form.

Submission:

  • Once the form is complete, it needed to be submitted to the City Hall.
  • Along with the completed Japanese Birth Certificate, you will need:
    • Both parents' Passport or military ID if passport is not available (ORIGINAL)
    • Marriage Certificate (ORIGINAL)

Post-submission:
Once the birth certificate is submitted, it takes approx. 2 hours for them to process the paper. After 2 hours, you will need to request for a copy of Certificate of Acceptance of Birth Report (Shusshou jyuri shoumeisho). You will need this form for your baby's passport and SSN application. It costs 300yen per copy. Please bring Japanese yen and your passport or military ID for the personal verification. After you receive the certificate, a case manager will then translate the document in English.

Parking:
There is a parking structure crossed the street (left side of the City Hall). Please bring in your parking ticket with you so that it can get validated.

DEERS/TRICARE Enrollment:
Don't let your child lose TRICARE! You can get TRICARE for your child in two steps:

  1. Register your newborn or adopted child in the Defense Enrollment Eligibility Reporting System (DEERS). You must enroll in DEERS for TRICARE coverage.
  2. Choose a TRICARE health plan and enroll your child. Come to our TRICARE Office, Room 1C69 for assistance.

Cultural Tips:

While we have faith in the quality of care provided by the Japanese hospitals, you may get confused or frustrated by the language barrier and cultural differences. Here are some communication and culture tips:

The Japanese hospital may not have English-speaking personnel. The next section of this patient guide provides you with many useful phrases with Japanese translation. If you cannot find the phrase you need, and if you are not successfully communicating verbally, try writing down your questions for the staff and allowing them time to answer. Written English is generally better understood than spoken English. Most Japanese physicians can read English, so this may be an effective way to communicate to your provider. Case Management has English-Japanese quick reference cards available for use upon request.

TRICARE & Other Health Insurance (OHI)
If you have OHI, you must follow all rules pertained to that plan. Your OHI is considered your primary insurance and pays before TRICARE. You or your provider must file health care claims with your OHI before filing with TRICARE. After your OHI determines the amount it will pay, submit a copy of the payment determination and the itemized bill with your TRICARE claims. If you are covered under the Japanese Health System and want to utilize this benefit, please make sure this is known to the RMC Staff; they can provide information on how to utilize this program.

Proof of payment is required for all overseas health care and pharmacy claims, including claims for care received while traveling overseas. Proof of payment is necessary for TRICARE to validate claims and safeguards benefit dollars. Our Health Benefits Advisor (HBA) can offer further assistance for all claims issues.

Health Benefits Advisor (HBA)/ Beneficiary Counseling Assistance Coordinator (BCAC)/Debt Collections Assistance Coordinator (DCAO)

Tricare Operations Program Manager

Transportation / Getting Around:

Car Rental:

  • DSN: 315-243-4456
  • An International Driver's License is required if you do not have a US Forces Japan Driver's License. International Driver's License can be obtained through your local AAA.

Taxi:

  • Radio Taxi: 045-226-3161
  • Radio Ashhi Taxi: 045-641-9875
  • CFAY Security Office will assist you if you are not sure how to call a taxi in Japanese. Please call 045-281-4111/4112 or DSN 242-411/4112 for assistance.

Base Shuttle:

On Base Bus: There are two busses that run on base, a clockwise and counter clockwise. Each bus makes multiple stops and will get you to your destination on base. A bus schedule is located at every bus stop and at the front desk of your billeting.

Japanese Public Transportation System

Visit www.hyperdia.com for most up to date schedule. Google maps also works and will give you the train route, cost, and next departing train time

Accommodations for Visiting Family:

Navy Lodge:

  • DSN: 315-243-6708
  • Comm: 046-816-6708
  • Check-in: 1500
  • Check-out: 1200
  • The Navy Lodge is open 24 hours (guest services provides reservations after office hours.) the lodge has a total of 166 rooms - all 166 rooms are adjoining rooms with queen beds. Kitchens are available in select rooms they are complete with cooking and dining utensils. There is complementary breakfast in the lobby from 0600 to 0900. Free Wifi available in the lobby and in every room.
  • NOTE: When making reservations be sure to specify if you are on Medical TAD orders

Navy Lodge:

  • DSN: 315-243-7317
  • Comm: 046-816-7317
  • Check-in: 1500
  • Check-out: 1200
  • The Navy Gateway Inn and Suites is open 24 hours (guest service's provides reservations after office hours.) The Gateway has a total of 100 rooms - 50 rooms have queen size beds and 50 rooms have full beds. Kitchens are available in every room they are complete with cooking and dining utensils. Video rentals are free. Free Wifi available in the lobby and free internet connection in every room (hard connection).
  • NOTE: When making reservations be sure to specify if you are on Medical TAD orders