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Primary Care Transformation

Tennessee's Primary Care Transformation strategy will assist providers in promoting better quality care, improving population health, and reducing the cost of 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 of and practice standards of primary care providers, and the overall value of health care delivered to the TennCare population.

Tennessee has built on the existing PCMH efforts by providers and payers in the state to create a robust PCMH program that features alignment across payers on critical elements. A PCMH Technical Advisory Group of Tennessee clinicians was convened in 2015 to develop recommendations in several areas of program design including, quality measures, sources of value, and provider activity requirements. Following much stakeholder input and design work, TennCare’s three health plans launched a statewide aligned PCMH program with 29 practices on January 1, 2017.

Tennessee Health Link: The primary objective of Tennessee Health Link is to coordinate health care services for TennCare members with the highest behavioral health needs.

TennCare has worked closely with providers and TennCare’s three health plans to create a program to address the diverse needs of these members. A Health Link Technical Advisory Group of Tennessee clinicians and practice administrators was convened in 2015 to develop recommendations in several areas of program design including, quality measures, sources of value, and provider activity requirements. The design of Health Link was also influenced by federal Health Home requirements. The Health Link program began statewide on December 1, 2016.

Care Coordination Tool: Tennessee has developed a shared Care Coordination Tool that will allow providers participating in the Patient Centered Medical Home (PCMH) and Tennessee Health Link programs to be more successful in the state’s new payment models.  The tool will identify and track the closure of gaps in care linked to quality measures. It will also allow providers to view their member panel and members’ risk scores, which will facilitate provider outreach to members with a higher likelihood of adverse health events.  The tool will also enable users to see when one of their attributed members has had an admission, discharge, or transfer from a hospital, such as a visit to the emergency room, and track follow-up actions. The Care Coordination Tool was rolled out to PCMH and Tennessee Health Link providers in February 2017.

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