Faced with growing financial constraints and critical population health issues among their Medicaid patients, two major academic medical centers—East Tennessee State University (ETSU) and University Clinical Health (UCH), affiliate of University of Tennessee (UT) Health Science Center—partnered with TennCare, Tennessee’s Medicaid agency, on a value-based Medicaid managed care supplemental payment initiative. This program—designed and implemented by Sellers Dorsey—has resulted in a measured increase in care coordination and enhanced access to health services for Medicaid enrollees in Tennessee.
Sellers Dorsey worked with ETSU, UCH and TennCare to create a new funding stream, focused on three main priorities:
Among several of its notable outcomes, the Tennessee Academic Affiliate Physician Directed Payment Program has achieved:
Sellers Dorsey worked with TennCare and the physician practice plans at ETSU and UCH on the following:
This program involves one of the most robust quality-based scoring methods in the country, featuring 21 quality metrics including 12 patient-centered medical home (PCMH) measures.
“Because of this program, we have quadrupled access to behavioral health services, and we have been better positioned to support our communities during the challenges of COVID-19.
Rusty Lewis, Associate Dean for Finance & Administration, ETSU