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Episodes of Care

TennCare’s Episodes of Care program aims to transform the way specialty and acute healthcare services are delivered by incentivizing high-quality, cost-effective care, promoting evidence-based clinical pathways, encouraging care coordination, and reducing ineffective or inappropriate treatments.

Episodes of Care involve acute or specialized patient interactions over a specific time period. The program assigns a single principal accountable provider (or “quarterback”) who has the most impact on the overall cost and quality of a patient’s treatment within an episode. The episode can include services from multiple providers, but the episode is designed to only include spend relevant to the episode.

Contact us at payment.reform@tn.gov

Introduction to Episodes

Visit this page for educational materials about TennCare’s Episodes of Care program. Information includes frequently asked questions, what is an episode, how to read your provider report, and more.

Results & Changes

Visit this page for Episodes of Care program results by performance year, design changes for the upcoming performance year, and more.

Events & Webinars

Visit this page for opportunities to learn about the Episodes of Care program, engage with TennCare’s three managed care organizations, and meet other providers in the program.

Technical Documents

Visit this page for each episode’s Detailed Business Requirements (DBR), Configuration File, and Executive Summary. This page also has the Episodes of Care cost and quality thresholds by performance year.