Tennessee Health Care Innovation Initiative

Success in Delivery System Transformation

TennCare is seeing positive results from several ambitious changes it has made to how health care is paid for and delivered in Tennessee. These reports from TennCare on its Delivery System Transformation programs provide the most complete picture to date of how the state’s innovative programs are resulting in improvements in the care that is being received by TennCare members as well as significant savings for Tennessee taxpayers. The three programs are Tennessee Health Link, Patient-Centered Medical Homes, and Episodes of Care.

Tennessee's Health Care Innovation Initiative is changing the way health care is paid for in Tennessee, moving from paying for volume to paying for value. Our mission is to reward health care providers for high quality and efficient treatment of medical conditions and help maintaining people's health over time.

The Tennessee Health Care Innovation Initiative's three strategies - primary care transformation, episodes of care, and long-term services and supports - are bringing together health care providers and clinicians, employers, major insurance companies, and patients and family members to reform the health care payment and delivery system in our state.

Tennessee is leading by example with our TennCare program and our state employees benefits administration, and we are asking other stakeholders to join us in statewide payment and delivery system reform.

Contact us at payment.reform@tn.gov for more information.

Three strategies

The Tennessee Health Care Innovation Initiative has three strategies, primary care transformation, episodes of care, and long-term services and supports.

  • Primary care transformation focuses on the role of the primary care provider in promoting the delivery of preventive services and managing chronic illnesses over time. The initiative has developed an aligned model for Patient Centered Medical Homes (PCMH), Tennessee Health Link for TennCare members with the highest behavioral health needs as well as a shared care coordination tool that allows providers to identify and track the closure of gaps in care linked to quality measures.
  • Episodes of care focus on the health care delivered in association with acute health care events such as a surgical procedure or an inpatient hospitalization. Episodes encompass care delivered by multiple providers in relation to a specific health care event.
  • The long-term services and supports (LTSS) component focuses on improving quality and shifting payment to outcomes-based measures for the QuILTSS program and for enhanced respiratory care.