TMA Meets with Haslam Administration on Episodes of Care Expansion

February 3, 2017

TMA is fighting for physicians against a push to move Episodes of Care payment models into commercial insurance plans.

TMA representatives met yesterday with Deputy to the Governor and Chief of Staff Jim Henry to outline a number of concerns about expanding the Episode of Care model from TennCare into commercial plans, including the plan covering state employees.

TMA’s Board of Trustees at its January meeting voted to oppose the expansion of the Episodes of Care program until several remaining physician concerns about episode design and implementation are addressed.

TMA has been promised a response from the Haslam administration on its concerns.

BlueCross BlueShield of Tennessee and Cigna recently sent out provider contract amendments to some specialists asking them to agree to participate in the state’s Episodes of Care payment reform initiative for the state employee heath plan.

The program, currently only used in the TennCare system, provides opportunities for bonus payments for providers but also comes with the risk of penalties depending on the costs of an episode of care.

If providers don’t agree to the amendment, they run the risk of being terminated from the health insurers' provider networks. That risk is especially high for physicians in small practices.