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Patient-Centered Medical Homes (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 the existing PCMH efforts by providers and payers in the state to create a robust PCMH program that features alignment across payers on critical elements. A PCMH Technical Advisory Group of Tennessee clinicians was convened in 2015 to develop recommendations in several areas of program design including, quality measures, sources of value, and provider activity requirements. Following much stakeholder input and design work, TennCare’s three health plans launched a statewide aligned PCMH program with 29 organizations on January 1, 2017.

PCMH providers commit to member centered access, team based care, population health management, care management support, care coordination, performance measurement and quality improvement. Participating providers receive training and technical assistance, quarterly reports with actionable data, and access to the care coordination tool. These providers are compensated with ongoing financial support and an opportunity for an annual outcome payment based on quality and efficiency performance.

Tennessee is also partnering with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) to implement a portfolio of quality improvement projects with Tennessee pediatricians that meet the distinct health care needs of infants, children and adolescents. Since 2008, TNAAP has collaborated with the Bureau of TennCare in a multi-year medical home implementation project to promote Pediatric PCMH implementation across the state.

Contact us at payment.reform@tn.gov for more information.