We work tirelessly to ensure that every Tennessean has real access to the right care and supports.
Value-based care is a new approach to delivering better health, better care and lower costs. Rather than compensating physicians, hospitals, Federally Qualified Health Centers (FQHC) and other health care providers based on volume, VBC programs reward physicians for keeping people healthy, enhancing care coordination and following clinical best practices.
Episodes of Care
Our episodes based payment seeks to align provider incentives with successfully achieving a patient’s desired outcome during an “episode of care.” An episode of care is acute or specialist-driven health care delivered during a specific time period to treat a physical or behavioral health condition. Episodes reward high-quality care, promote the use of clinical pathways and evidence-based guidelines, encourage care coordination and reduce ineffective and/or inappropriate care.
Patient-Centered Medical Home (PCMH)
PCMH is a comprehensive care delivery model designed to improve the quality of primary care services for TennCare members, the capabilities and practice standards of primary care providers and the overall value of health care delivery to the TennCare population.
Tennessee Health Link (THL)
The primary objective of THL is to coordinate health care services for TennCare members with
the highest behavioral health needs. Through better coordinated behavioral and physical health
services, THL is meant to produce improved member outcomes, greater provider accountability,
flexibility when it comes to delivery of appropriate care for each individual and improved cost
control for the State.
TennStar serves as a value-based incentive opportunity that uses quality performance measure compliance. TennStar is intended for any of our providers who carry a combined product (i.e. Medicaid/DSNP) member assignment of at least 100 members. The performance measures of high interest to our plan and population are identified on an annual basis for inclusion