November Update: Tennessee Health Care Innovation Initiative

November 4, 2016

Primary Care Transformation
Primary Care Transformation continues to unfold with informational webinars held for Patient-Centered Medical Home and Tennessee Health Link providers. Webinars provided high level overview with an opportunity for pilot providers to ask questions. Materials from the HL and PCMH webinars are available to review.

Operation manuals for HL and PCMH programs provide the model and fundamentals on the care coordination tool, training, payments, efficiency and quality metrics.

TennCare announced it has contracted with Navigant to deliver provider training and technical assistance services to PCMH and HL providers across the state. As part of the technical assistance, Navigant will conduct initial practice assessments to identify current capabilities and gaps. This allows the trainer to create a custom curriculum for each practice to meet the transformation milestones.

Episodes of Care
State Planning and Innovation Group (SPIG) released first-year episode results for Wave 1 (perinatal, acute asthma exacerbation, and TJR). Overall, the state saw a reduction in average episode cost (risk –adjusted) from 2014 to 2015.

  • The aggregate reduction in episode cost for Wave 1 was $6,293,403 (based on 34,003 valid episodes).

  • Perinatal exhibited the smallest decrease at 3.4 percent in per average (risk-adjusted) episode cost, but had the largest total reduction in episode cost at $4,719,519.

  • Although the acute asthma exacerbation saw a larger decrease in average per-episode cost at 8.8 percent, this translated into a total reduction in episode cost at $1,308,279.

  • Total Joint Replacement (TJR) had the smallest total reduction in episode cost at $265,605 with an average per episode cost (risk adjusted) reduction of 6.7 percent.

Reward payments to providers were made based not only on low cost, but also the ability to meet all quality measures tied to gain sharing. More dollars went to rewards than penalties.

  • Reward payments for Wave 1 totaled $665,065.

  • Perinatal providers received $527,466 while the acute asthma exacerbation portion was $112,671, and the TJR portion was $24,938.

  • In contrast, providers who were above the acceptable threshold received invoices in the amount of $371,028 with a penalty breakdown consistent of perinatal ($244,953), asthma ($103,410), and TJR ($22,664). Final net balance (in favor of rewards) for W1 was $294,037. 

State SIM Population Health Improvement
On Sept. 29, Governor Haslam signed and approved the 2015 Edition of the State Health Plan, making it official state health policy.

The Tennessee Department of Health (TDH) is in the process of developing a common definition of population health and ways to measure population health and improvement. Utilizing public workshops across the state, TDH is attempting to develop a regional consensus on the key principles and indicators of population health. TDH conducted meetings in Memphis on Oct. 13, Nashville on Oct. 21, Knoxville on Oct. 26, Jackson on Oct. 28 and Chattanooga on Nov. 4. The final workshop will be held in Gray on Nov. 9 from 1 to 5 p.m. EST at the ETSU Natural History Museum. TDH is also holding stakeholder-specific workshops for partner groups to get feedback on defining and measuring population health, starting with Cumberland Pediatric Foundation, the Hospital Alliance of Tennessee and the YMCA. The results and feedback generated during these workshops will be incorporated into the TSHP, the state’s main health policy tool, and are anticipated to eventually be incorporated into a web-based dashboard. If interested in having TDH conduct a workshop for your hospital or organization, please contact Christina Hartlage at or 615.741.1739.