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Episodes of Care

Success in Delivery System Transformation

TennCare is seeing positive results from several ambitious changes it has made to how health care is paid for and delivered in Tennessee. These reports from TennCare on its Delivery System Transformation programs provide the most complete picture to date of how the state’s innovative programs are resulting in improvements in the care that is being received by TennCare members as well as significant savings for Tennessee taxpayers. The three programs are Tennessee Health Link, Patient-Centered Medical Homes, and Episodes of Care. 

 

Episode-based payment seeks to align provider incentives with successfully achieving a patient's desired outcome during an “episode of care,” which is acute or specialist-driven health care delivered during a specified time period to treat a physical or behavioral condition. Episodes reward high-quality care, promote the use of clinical pathways and evidence-based guidelines, encourage coordination, and reduce ineffective and/or inappropriate care. Episode-based payment is applicable for most procedures, hospitalizations, acute outpatient care (e.g., broken bones), as well as some forms of treatment for chronic (e.g., cancer) and behavioral health conditions (e.g., ADHD). 

To sign up for the Episodes of Care Newsletter, go to: https://stateoftennessee.formstack.com/forms/episodes_newsletter_subscribe

For more information on individual Episodes of Care, please reference the following:​

This figure depicts a typical Episode of Care.

This figure depicts a typical Episode of Care. Episodes of Care focus on the health care delivered in association with acute health care events and are triggered by specific claims filed by a facility, provider group or individual provider. The episode duration, or episode window, can include the time before the trigger (pre-trigger), during the trigger period and after the trigger (post-trigger). Services and procedures such as diagnostic imaging, medications, and outpatient services performed by multiple providers before, during, and after the triggering event can be included depending on the episode.

KEY DOCUMENTS

OVERVIEW OF EPISODES OF CARE

PROVIDER REPORTS

MORE INFORMATION

For questions about the initiative, email payment.reform@tn.gov