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 is May 21st, 2019.
TennCare is hosting our annual episodes feedback session for stakeholders to share successes, ask questions, and recommend changes to improve episode design. The feedback session will be live streamed across the state, and participants may share their feedback at all 6 locations: Nashville, Johnson City, Jackson, Knoxville, Memphis, and Chattanooga.
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.
OVERVIEW OF EPISODES OF CARE
- Introduction to Episodes of Care
- TennCare episode of care program description
- Episodes of Care Sequence
- 2019 Episodes of Care Thresholds
- 2016 TennCare Episodes of Care Results
- 2018 Episodes of Care Thresholds
- TennCare Episodes 2017 Results
- Memo: 2019 Episodes Changes
- Episodes of Care Memo on 2018 Pain Relief Legislation
For questions about the initiative, email firstname.lastname@example.org