Episodes of Care
TennCare’s Episodes of Care program aims to transform the way specialty and acute healthcare services are delivered by incentivizing high-quality, cost-effective care, promoting evidence-based clinical pathways, encouraging care coordination, and reducing ineffective or inappropriate treatments.
Episodes of Care involve acute or specialized patient interactions over a specific time period. The program assigns a single principal accountable provider (or quarterback) who has the most impact on the overall cost and quality of a patient’s treatment within an episode. The episode can include services from multiple providers, but the episode is designed to only include spend relevant to the episode. There are a total of 48 specific episodes that have been developed since the program began in 2014.
The retrospective episode model is designed to reward providers for high-quality, cost-effective care for TennCare members. The retrospective model is a step toward moving our system from paying for volume to paying for value. Because it is retrospective, current fee-for-service payment agreements will not be affected. All TennCare payers are participating in Episodes of Care (EOC). Participation is not optional for providers.
You can see all the Episodes of Care waves and methodologies online: