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
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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:
Episodes of care reportsThe 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 factorsThresholds 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 Program Guide
- THCII FAQs
- 2025 Thresholds
- 2026 Thresholds
- 2025 Gainsharing Limits
- 2026 Gainsharing Limits
- Risk Adjustment
Detailed Business Requirements
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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
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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 INITIATIVES
Enhancing care in our state
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Working together
As a provider in our BlueCare Tennessee networks, we trust you. We know you know how to take care of your patients. Our quality campaigns, tip sheets and clinical information aren’t intended as medical advice or direction for the care you provide, but to provide helpful tips and show you the best way to document care for the claims you submit based on your patients’ conditions.
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National quality care standards
Improving the health of your patients and our members is a goal we share, and we intend to work with you toward meeting and exceeding national standards of health care for them. Our standard of quality is set by the National Committee for Quality Assurance (NCQA) and is followed by more than 90% of the country’s health plans.
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HEDIS® scores
NCQA evaluates our health plan performance with the Healthcare Effectiveness Data and Information Set – better known as HEDIS. Our HEDIS scores are a measure of how well providers in our networks deliver care to members based on several factors, including effectiveness of care, ease of access and patient experience.
HEDIS® is a registered trademark of the National Committee for Quality Assurance.