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.