Primary Care Transformation a Priority for TennCare

By MELANIE KILGORE-HILL


Primary Care Transformation a Priority for TennCare  | Gov. Bill Haslam, Tennessee Health Care Innovation Initiative, TennCare, Pharmacy Pilot Program, PCMH, Victor Wu, Care Coordination, Value-Based Care

Victor Wu, MD

Five years after Gov. Bill Haslam introduced the state's Health Care Innovation Initiative, efforts are in full swing. The plan was designed to revamp the way healthcare is paid for - moving from volume to value. The initiative's three strategies included episodes of care, long-term services/supports and primary care transformation.


Primary Care Transformation

Primary Care Transformation focuses on the role of the primary care provider in promoting the delivery of preventive services and managing chronic illnesses over time. Since its inception, the initiative has developed an aligned model for Patient Centered Medical Homes, the first of its three initiatives. In 2017 TennCare's three health plans launched a statewide-aligned PCMH program with 29 organizations.


Tennessee Health Link

The second component of the transformation initiative included a Tennessee Health Link for TennCare members with the highest behavioral health needs. TennCare has since worked closely with providers and TennCare's three health plans to create a program to address the diverse needs of these members.

A Health Link Technical Advisory Group of Tennessee clinicians and practice administrators was convened in 2015 to develop recommendations in several areas of program design including quality measures, sources of value, and provider activity requirements. The design of Health Link was also influenced by federal Health Home requirements. The Health Link program began statewide on December 1, 2016.


Pharmacy Pilot Program

In February 2018, TennCare announced the launch of a new pilot program that will further support primary care transformation through a two-year medication therapy management pilot program.

The MTM pilot focuses on providing the best therapeutic outcomes for individual TennCare members. Pharmacists participating in the pilot project will provide MTM services in PCMH and Tennessee Health Link settings to help TennCare members get the most benefit from their medications.

TennCare officials said the goal of the MTM pilot is to work with members to actively manage their drug therapy by identifying, preventing and resolving medication-related problems. TennCare plans to study the impact of incorporating pharmacists into the extended care team during the pilot period.

"Pharmacists play an integral role in our member's health journey," said TennCare Chief Medical Officer Victor Wu, MD. "Engaging our members on how to use their medications and manage their diseases is essential to empowering them to take control of their own health. Integrating pharmacists with primary care and mental health providers in a collaborative care team approach can be highly impactful."


Care Coordination Tool

In addition, Tennessee has developed a shared care coordination tool that allows providers participating in the PCMH and Tennessee Health Link programs to be more successful in the state's new payment models. The tool has been designed to identify and track the closure of gaps in care linked to quality measures.

It also allows providers to view their member panel and members' risk scores to facilitate provider outreach to members with a higher likelihood of adverse health events. Additionally, the tool enable users to see when one of their attributed members has had an admission, discharge, transfer from a hospital, or ED visit and track follow-up actions. The Care Coordination Tool was rolled out to PCMH and Tennessee Health Link providers in February 2017.

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TennCare Primary Care Transformation