Tennessee Health Care Innovation Initiative Project
The State of Tennessee launched the Tennessee Health Care Innovation Initiative (THCII) to help improve the health of Tennesseans and address health care spending by changing the way health care is paid for in Tennessee. By moving toward a reimbursement model that pays providers based on quality and value rather than volume, doctors and hospitals are rewarded for delivering high quality, efficient medical care.
THCII is focused on three key areas: Episodes of Care, Tennessee Health Link and Patient-Centered Medical Homes.
Episodes of Care
Episode-based payment models focus on acute health care events, delivered by more than one provider. Providers in the best position to influence the quality and cost of care for an event are assigned as Principal Accountable Providers, who are known as Quarterbacks.
Quarterbacks whose leadership and care coordination deliver quality, cost-efficient care receive rewards beyond current reimbursement rates.
To see the details of each episode of care, please visit the State’s website.
Please see below for important updates about the Episodes of Care program:
TennCare Memo: Waiving 2019 Episodes Risk-Sharing Payments
TennCare Memo: Waiving 2020 Episodes Risk-Sharing Payments
TennCare Memo: 2022 Episode Changes
Episodes of Care Reports
The data collected during the process is compiled in quarterly reports which allow Quarterbacks to measure their performance against cost and quality metrics. Quarterly reports are available through BlueAccess.
If you have questions, please contact your Network Manager. If you do not know who your Network Manager is, click here to locate your BlueCross contact.
Episodes of Care and Other Resources
- Risk Factors
- Value-Based Payment Dispute Resolution Procedure
- THCII Provider Guide
- 2017 Thresholds
- 2018 Thresholds
- 2019 Thresholds
- 2020 Thresholds
- 2021 Thresholds
- 2022 Thresholds
- 2023 Thresholds
- Gain Share Limits
- Risk Adjustment
- State of Tennessee THCII Resources
The Journey Program
The Division of TennCare has evaluated low-volume episodes in the Episodes of Care program and identified challenges that aren’t addressed by the program and influence cost and quality. The Journey Program is designed to ease these challenges for two low-volume episodes: total joint replacement and bariatric surgery.
To learn more about the program and the Journey Partners in each region, please click here. We encourage you to refer patients who need total joint replacement or bariatric surgery to the appropriate regional Journey Partner for care.
If you have questions about the program, please contact your Provider Network Manager.
Tennessee Health Link
People with severe and persistent mental illness often have higher rates of asthma, diabetes, high blood pressure and many other conditions. The State of Tennessee is working to better integrate care for people who suffer with physical and mental health issues. For more information, please visit the state’s Tennessee Health Link web page.
Patient-Centered Medical Homes
The Patient Centered Medical Home (PCMH) is a holistic model of care for patients directed by a primary care provider (PCP). With the goal of preventing unneeded hospital and emergency room visits, PCPs coordinate with other providers to deliver the right care, in the right place and time to their patients. To learn more, please see our
- PCMH Program Guide
- PCMH and THL Attestation Quick Reference Guide
- Visit the state's PCMH web page
- Quality Interactions Cultural Competency Training