2026 Tennessee Health Link Quality Metrics Table and Thresholds
| Core Quality Metric | Description | Threshold |
|---|---|---|
| 1. Metric Monitoring for Children and Adolescents on Antipsychotics (HEDIS APM-E) | The percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing | ≥ 38.00% |
| 2. Controlling High Blood Pressure (HEDIS CBP) | Percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year |
≥ 58.00% |
| 3. Eye Exam for Patients with Diabetes (HEDIS EED) | Percentage of members 18-75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed |
≥ 51.00% |
4. Follow-Up after Substance-Use Visit Within 30 Days (HEDIS FUA) · 30-day |
The percentage of emergency department (ED) visits among persons age 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up within 30 days of the ED visit. |
≥ 35.00%
|
5. Follow-Up After Hospitalization for Mental Illness Within 7 Days (HEDIS FUH) · 7-day |
The percentage of discharges for persons 6 years of age and older who were hospitalized for a principal diagnosis of mental illness, or any diagnosis of intentional self-harm, and had a mental health follow-up service. |
≥ 53.00% |
6a. 7-day Psychiatric Hospital Readmission Rate (TennCare Custom RTF) · 7-day |
Rate of psychiatric hospital or RTF readmissions within 7 days |
≤ 5.00% |
6b. 30-day Psychiatric Hospital Readmission Rate (TennCare Custom RTF) · 30-day |
Rate of psychiatric hospital or RTF readmissions within 30 days |
≤ 13.00% |
| 7. Adherence to Antipsychotic Medications for Individuals with Schizophrenia (HEDIS SAA) | The percentage of members 18 years of age or older during the measurement year with schizophrenia or schizoaffective disorder who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period |
≥ 65.00% |
| 8. Diabetes Screening for People With Schizophrenia or Bipolar Disorder (HEDIS SSD) | The percentage of members 18–64 years of age with schizophrenia, schizoaffective disorder or bipolar disorder, who were dispensed an antipsychotic medication and had a diabetes screening test during the measurement year |
≥ 86.00% |
9a. Child & Adolescent Well-Care Visits 7-11 years (HEDIS WCV) · Ages 7 – 11 years |
Percentage of enrolled members 7-11 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year |
≥ 65.00% |
9b. Child & Adolescent Well-Care Visits 12-17 years (HEDIS WCV) · Ages 12 – 17 years |
Percentage of enrolled members 12-17 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year |
≥ 57.00% |
9c. Child & Adolescent Well-Care Visits 18-21 years (HEDIS WCV) · Ages 18 – 21 ye |
Percentage of enrolled members 18-21 years of age who had at least one comprehensive well-care visit with a PCP or OB/GYN during the measurement year |
≥ 39.00% |