Tennessee Payment Reform Initiative

The state of Tennessee, with a grant from the Centers for Medicare & Medicaid Services (CMS), has launched an initiative to transition its healthcare payment system to better reward patient-centered, high quality, high-value healthcare outcomes for all Tennesseans. The initiative is led by the Tennessee Department of Finance and Administration (the division of state government that includes TennCare), but includes a broad coalition of stakeholders, including the largest private insurers in Tennessee, with close involvement from many leading healthcare providers. The state finalized its strategy in 2013 and will begin phased implementation in 2014.

Tennessee’s payment reform initiative is a top priority for Governor Bill Haslam. During a joint session of the General Assembly in March 2013, the governor declared Tennessee would become a “model for what true health care reform looks like.” Over the next three to five years, the initiative plans to migrate a majority of healthcare spending across Tennessee’s public and private sector into outcomes-based payment and service delivery models.

Two key components of the plan are primary care medical homes and retrospective bundled payments for defined episodes of care. The plan initially will include services provided to TennCare enrollees and Tennessee state employees.

THA has been working with the TennCare Bureau on this new program. Below are resources and information about the initiative and current status.

Resources and Information

  • Tennessee Payment Reform Initiative Webinar: Slides | Audio (Nov. 5, 2013)
    Intended to help hospitals understand the new program and clarifies issues and convers identified by THA in ongoing conversations with the bureau.
  • GIQuIC Registry Webinar: One of the episodes in Wave 2 of the TennCare Payment Reform Initiative that will begin the first performance period on January 1, 2016 is screening and surveillance colonoscopy. In an effort to begin to have more meaningful quality measures for that retrospective episode, the TennCare Bureau included “ the percentage of procedures done in facilities that participate in GIQuIC” as the measure that must be passed in order for the physician quarterback to receive a reward. The threshold percentage to earn the gain share payment has not yet been set. THA is hosting this webinar to provide members more information about the GIQuIC registry, the features and benefits, and to provide a demonstration of the functionality and the reporting capabilities.” To view the presentation, click here.

For current information on the initiative, along with presentations from provider, public and employer meetings, click here.