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Sommers, A. S., Hennessy, C. M., Erickson, E., Rutledge, R. I., Feinberg, R. K., Bingaman, A. R., Britvec, M. A., & Crews, M. L. (2021). Tennessee Perinatal Episode of Care Model: Fact sheet. Medicaid and CHIP Payment and Access Commission (MACPAC). Medicaid and CHIP Payment and Access Commission (MACPAC) https://www.macpac.gov/wp-content/uploads/2021/09/Tennessee-Perinatal-Episode-of-Care-Model.pdf
In 2014, TennCare, the Tennessee Medicaid program, began implementing statewide episode of care payment models under its Health Care Innovation Initiative. The perinatal episode was one of the first models implemented. Currently, the state supports 48 episodes in total. TennCare administers its Medicaid program through managed care, and Medicaid managed care organizations (MCOs) and TennCare jointly administer the episode of care model. Commercial payers may also adopt the models. The goal of the perinatal episode is to reduce variation in costs and reward providers who deliver costeffective, quality care, and promote patient-centered, high-value health care. The model creates payment incentives for providers to manage costs across the entire episode of care. Accountable providers are held financially responsible when their costs are higher than what is considered acceptable. Conversely, they are also eligible for additional payments when their costs are below what is considered commendable, as long as certain quality metrics are met. Under contract with MACPAC, RTI International conducted interviews and examined five states (Arkansas, Connecticut, Colorado, North Carolina, and Tennessee) implementing value-based payment initiatives to improve maternity care in Medicaid. This case study includes an overview of the Tennessee perinatal model, details how the model is defined, describes the payment methodology, and summarizes the available research on the model’s effects on cost and quality.1 MACPAC has also published case studies for the other study states, as well as an issue brief summarizing the key findings (MACPAC 2021a–e).
