TennCare Reduces Costs, Improves Outcomes Through Primary Care Transformation

Challenge

In 2016, as TennCare, Tennessee’s Medicaid agency, embarked on ambitious changes to care delivery and payment, one of its goals was to better coordinate care for members with significant behavioral health needs.

TennCare established Tennessee Health Link (THL), a statewide network of community mental health providers that serves 70,000 TennCare members. With the help of a State Innovation Model grant, TennCare sought to identify ways to work with primary care providers to coordinate behavioral and physical care while reducing costs.

Solution

TennCare partnered with Guidehouse on a three-year engagement to execute its primary care transformation strategy, designed to coordinate behavioral health with primary care services. TennCare’s strategy consisted of three components:

1. Designing a patient-centered medical home (PCMH) model to improve quality of care delivery for TennCare members by helping practices achieve National Committee for Quality Assurance (NCQA) PCMH recognition
2. Enhancing care coordination for TennCare members with the greatest behavioral health needs by partnering with behavioral health organizations
3. Developing a web-based care coordination tool to allow PCMH and THL teams to more effectively coordinate efforts by identifying and tracking gaps in care, member risk scores, and admissions, discharges, and transfers

Guidehouse worked closely with TennCare, its three health plans, and the PCMH and THL practices to drive practice transformation. Activities fell into four buckets.

Physician practice assessments. Guidehouse evaluated the readiness of practices to move to PCMH and behavioral health home models. Assessments were conducted onsite for each of the participating practices.

One-on-one practice coaching. Guidehouse practice transformation coaches used the assessment results to provide regular, in-person coaching and technical assistance to shepherd primary care practices through the NCQA PCMH recognition process. Coaching also was designed to help THL practices transition to the health home model and to empower all practices to undertake quality measure improvement. Guidehouse also developed a customized curriculum of evidence-based practices to use during coaching sessions and to be accessed on demand.

Group training and collaboration. Guidehouse conducted nearly 200 learning collaboratives and about 30 conferences across Tennessee to educate providers on key topics and initiatives and share best practices in coordinating behavioral health with primary care. The team also worked with community mental health centers to identify best practices around delivery of mental health and substance use services.

Remote training. Guidehouse conducted more than 35 webinars and video trainings across a wide range of topics to help practices to operate more effectively, learn about TennCare initiatives, and address common challenges identified through coaching and collaboratives. The topics included behavioral health crisis planning and coordinating the behavioral health continuum of care.

These efforts made a significant impact on quality of behavioral healthcare and access to care for Tennessee’s Medicaid patients.

“Within three years, our work in integrating behavioral health with primary care services led to a 3% reduction in total costs of care for Medicaid patients and an 11% decrease in inpatient hospital admissions,” said Ellyn Wilbur, Executive Director, Tennessee Association of Mental Health Organizations. “Availability of on-the- ground expertise and one-on-one support for physicians made a significant difference for our program and elevated health outcomes for vulnerable populations.”

Impact

TennCare’s partnership with Guidehouse, PCMHs, and THLs has led to:

• A 3% reduction in total care of care associated with the PCMH program.
• Nearly $23 million in performance bonus payments for PCMHs and THLs.
• A decrease in members' inpatient hospital admissions by 11% through one-on-one interactions and primary care follow up.
• Improvement in performance on 16 out of 18 care quality measures among PCMH members from 2016-2018. Nearly 350 practice sites achieved NCQA PCMH recognition.
• Training and technical support for more than 85 PCMH practices and 21 THLs.