TennCare Managed Care Organizations

Program Location: 
Nashville, TN
Payer Type: 
BlueCross BlueShield of Tennessee

Tennessee has the only Medicaid program in the country that requires all Medicaid recipients to be enrolled in managed care. Beginning in 2007, the program integrated behavioral health and substance abuse treatment services into the services offered by the MCOs. In 2010, the program integrated long-term services and supports for persons who are elderly or physically disabled into the services offered by the MCOs. At present there is work underway to improve coordination of care for persons who are dually eligible for Medicare and TennCare.

In order to accelerate PCMH adoption, the state will lead by example, requiring TennCare MCOs to enroll a certain percentage of their members into population-based models within a given timeframe. TennCare’s MCOs will align on a set of common design decisions, such as quality metrics. MCOs will also jointly invest in PCMH learning collaborative tools and explore the use of shared care coordinators. The state will also invest in infrastructure; future plans may include performance reporting to all primary care providers in the state leveraging the All Payer Claims Database, as well as development of a multi-payer portal. The state will consider investments into shared local care coordination capacity.

Improved Health: 
  • Medication compliance for persons with asthma increased from 51% in 2017 to 55% in 2018
Increased Preventive Services: 
  • Childhood immmunization rates increased from 2017 to 2018
  • Counseling for physical activity and nurtition increased from 2017 to 2018
Last updated April 2019
Go to top