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 37% of TennCare Members (over 600,000) are attributed to one of the 83 PCMH-participating organizations at over 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 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.

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