QUALITY CARE INITIATIVES

Working together to provide the highest level of care

We know you’re committed to providing quality care to your patients. Here’s the information you need to help maximize your performance in our quality programs.

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Tennessee Health Care Innovation Initiative

THCII quality programs

Led by the state of Tennessee, THCII was created to lower costs and improve health care for Tennesseans. The program is designed to shift the health care system from volume-based to value-based, while protecting our members' physical and financial health by reducing ineffective or inappropriate treatments. In turn, doctors and hospitals are rewarded for delivering high-quality, efficient medical care.

The state of Tennessee launched the 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 Home.

State of Tennessee THCII resources

For questions, email the Division of TennCare at payment.reform@tn.gov

More about the THCII program

Episodes of Care
Episode-based payment models focus on acute health care events, with care 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, also 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 episodes of care, please visit the State's website.
Please see below for important updates about the Episodes of Care program:
TennCare Memo: 2024 Episode Changes
TennCare Memo: 2023 Episode Changes
Episodes of care reports
The data collected during the process is compiled in quarterly reports that allow Quarterbacks to measure their performance against cost and quality metrics. Quarterly reports are available in Availity®.If you have questions about your quarterly reports, please contact your Provider Network Manager. You can find the name of your Provider Network Manager here.
Episodes of care and other resources
Risk factors
2025
2026
Thresholds and other documents
Value-Based Payment Dispute Resolution Procedure
Value-Based Payment Appeal Form
Value-Based Payment Reconsideration Form
BlueCare Tennessee Provider Administration Manual
THCII FAQs
2025 Thresholds
2026 Thresholds
2024 Gainsharing Limits
2025 Gainsharing Limits
Risk Adjustment
Detailed Business Requirement
All Detailed Business Requirements
Tennessee Health Link (THL)
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 see the state's THL webpage.
THL resources
Quality Care Measures Booklet
Patient-Centered Medical Home (PCMH)
The PCMH is a holistic model of care for patients directed by a primary care provider (PCP). With the goal of preventing unneeded hospital and ER visits, PCPs coordinate with other providers to deliver the right care, in the right place and time, to their patients. For more information, please visit the state's PCMH webpage.
PCMH resources
Quality Care Measures Booklet

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