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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:​

Annual Episodes Design Feedback Session was May 21st, 2019.

TennCare hosted the annual episodes feedback session for stakeholders to share successes, ask questions, and recommend changes to improve episode design. The feedback session was streamed live across the state, and participants shared their feedback at all 6 locations: Nashville, Johnson City, Jackson, Knoxville, Memphis, and Chattanooga.

Agenda for 2019 Episodes Design Feedback Session
2019 Episodes Design Feedback Session - Session 1
2019 Episodes Design Feedback Session - Session 2
2019 Episodes Design Feedback Session - Session 3

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