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.

Latest Episodes News

Tennessee physicians are celebrating an announcement from TennCare that the state will temporarily stop expanding its episodes of care payment model. TennCare will reportedly not design future episodes so it can dedicate more resources to maintaining and improving episodes already in place.

TMA has been asking the state for a pause-and-fix since fall 2017, when TMA strengthened its ongoing push for TennCare to improve the transparency, accuracy and effectiveness of the program.

TMA initially supported the states efforts to greate an alternative payment mechanism that would help control TennCare costs and promote quality care. The association worked with state officials to engage the medical community and help physicians successfully navigate the necessary transition from fee-for-service to value-based reimbursement. 

MORE NEWS ON EPISODES PAUSE

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 be 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.

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

What TMA Asked For

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.

TMA MANIFESTO

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.

GIVE FEEDBACK

Contact Us

Karen Baird, CPC, CPMA
Director of Insurance Affairs
615.460.1647
karen.baird@tnmed.org

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