Patient-Centered Medical Homes (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 existing PCMH efforts by providers and payers in the state to create a robust PCMH program that features alignment across critical elements. To date, approximately 40% of TennCare Members (nearly 700,000) are attributed to one of the 79 PCMH-participating organizations at over 490 Locations throughout the state. PCMH providers commit to member centered access, team-based care, population health management, care management support, care coordination, performance measurement and quality improvement. Participating providers receive training and technical assistance, quarterly reports with actionable data, and MCO Coaching to ensure success. These providers are compensated with ongoing financial support and an opportunity for an annual outcome payment based on quality and efficiency performance.

The selection process for the TennCare PCMH program is managed by the health plans (MCOs); each MCO will determine which organizations to include for PCMH participation. MCOs will manage their PCMH networks and may contract with preferred provider partners and/or increase membership to strong PCMHs.

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