Primary Care Transformation

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.

Tennessee's Primary Care Transformation strategy assists providers in promoting better quality care, improving population health, and reducing the cost of care.

Patient-Centered Medical Home (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 40% of TennCare Members (over 770,000) are attributed to one of the 83 PCMH-participating provider organizations at over 480 locations throughout the state.

Tennessee Health Link: Tennessee Health Link is a program offered by 18 mental and physical health providers that coordinate health care services for TennCare members with the highest behavioral health needs.

Care Coordination Tool: The Care Coordination Tool provides actionable, real-time information in a secure online portal to providers participating in the Patient Centered Medical Home (PCMH) and Tennessee Health Link programs to improve patient care and be more successful in the state’s value-based payment models. The tool enables users to view when an attributed member has had an admission, discharge, or transfer from a hospital, such as a visit to the emergency room, to improve care coordination. The tool also identifies and tracks the closure of gaps in care linked to quality measures. Additionally, it allows providers to view their member panels and members’ risk scores, which facilitates provider outreach to members with higher likelihoods of adverse health events.