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 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. To date, over 30% of TennCare members are attributed to one of the 67 PCMH-participating provider organizations at more than 400 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 access to the care coordination tool. 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 has transitioned to the health plans (MCOs). The previous application process administered by TennCare has been discontinued.

Each MCO will now determine which organizations to include for PCMH participation in CY 2019 going forward. MCOs will manage their PCMH networks and may contract with preferred provider partners and/or increase membership to strong PCMHs.

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