Tennessee Health Care Innovation Initiative

The Tennessee Healthcare Innovation Initiative, otherwise known as TennCare payment reform, is the state’s plan to reduce the cost of healthcare and increase quality by keeping providers accountable for the care they provide. TMA has worked since the program’s inception in 2012 to protect physicians’ interests, help members understand the complexities of new value-based reimbursement models, and advocate for improvements to the episodes of care program.

TMA Position on Episodes of Care

TMA recognizes that being more efficient about the cost of healthcare delivery to Medicaid patients is a legitimate public health issue for Tennessee. The state Innovation Initiative’s episodes of care program, now being implemented to address healthcare costs in the TennCare program, presently has major flaws in design and implementation that concern our member physicians.

For the time being, TMA will continue to seek representation on Technical Advisory Groups (TAGs) to assist the state in aspects of the technical design of episodes of care waves. We will also continue to advocate for substantial revisions to the design and implementation of episodes of care in the TennCare program. However, until these revisions are made and tested, TMA strongly opposes further expansion of the state’s episodes of care program.

TMA Advocacy Efforts

TMA has pursued all available avenues to try to improve the design and implementation of the episodes of care initiative.

  • Staff, Insurance Issues Committee, and other leadership meetings with state officials
  • Staff and leadership testimony to oversight committees of the General Assembly
  • Lobbying the General Assembly for legislative reforms
  • Nomination of blue chip physician specialists to the Technical Advisory Groups
  • Member advocacy during wave feedback sessions
  • Innovations Initiative consultant to educate physicians and serve as a liaison to the state
  • Educational programs for physicians and medical office staff
  • Facilitation of medical practice administrator calls with the state and MCOs
  • Hands-on instruction and counsel to gather practice perspectives to share with the state

TMA Manifesto

Despite TMA’s advocacy efforts, significant concerns remain about data collection, data reporting and accuracy, and overall transparency of the episodes of care program. TMA is opposed to further expansion of the initiative until or unless these fundamental issues are satisfactorily addressed and tested.


Give Your Feedback

TMA encourages physician members and medical practice staff to give feedback on episodes of care. Please tell us how the program affects your practice and patients.


Contact Us

Karen Baird, CPC, CPMA
Director of Insurance Affairs

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