TMA Position on Episodes of Care
TMA recognizes that being more efficient about the cost of healthcare delivery is a legitimate public health interest for Tennessee. The state Innovation Initiative’s episodes of care program, now being implemented to address healthcare costs in the TennCare program, continues to have major flaws in design and implementation that concern our member physicians. TMA will continue to advocate for substantial revisions to the design and implementation of the episodes of care program in the TennCare and state employee benefit programs, and oppose any expansion into commercial health insurance products in the state unless such expansion is voluntary and not tied to participation in any other product or line of business.
Until revisions are made and tested, TMA believes that the state Innovation Initiative for episodes of care should remain paused:
pending a truly independent evaluation of its costs;
until a trustworthy data verification process can be implemented and sufficiently tested;
until TMA is assured that that provider participation in episodes of care models for any type of product, including commercial health insurance products, is voluntary and never tied to participation with any other network or line of business;
until TMA is assured that the program for the state employee benefits is gain-sharing only.