TennCare III Shared Savings Quality Measures Protocols

From Division of TennCare: 

Providing high-quality care and supporting TennCare members to improve their health is a longstanding primary objective of the TennCare program. The TennCare III Demonstration waiver agreement certainly prioritizes this goal by directly tying any potential shared savings the state might achieve to maintaining or improving quality of care as measured by a set of quality performance measures. As valued partners and providers in the TennCare program, we wanted to update you on the selection of these measures.

As background, the Centers for Medicare and Medicaid Services (CMS) approved the TennCare III Demonstration waiver on January 8th and directed TennCare to submit a set of 10 Shared Savings Quality Measures within 60 days.

While TennCare was tasked with choosing each individual measure, CMS established parameters around the selection of the Shared Savings Quality measures which included: 

  • All quality measures must be selected from the Child Core Measure Set and Adult Core Measure Set.
  • The 10 measures must consist of at least three measures designated as a child measure, three measures designated as an adult measure, and three measures designated as a maternal measure
  • TennCare’s performance on the quality measures in Measurement Year 2019 (MY2019) is to be used to establish the initial baseline performance for the first 5 years of shared savings evaluation
  • TennCare will be able to earn a 45% share of any potential shared saved savings if TennCare maintains the baseline performance for the 10 measures
  • Broadly speaking, TennCare will experience a 10% percent reduction in potential shared savings for each measure where there is a significant decline from baseline performance for two consecutive years. TennCare can earn an additional 1% in shared savings for each measure with significant improvement from baseline performance.

TennCare worked thoughtfully to choose 10 measures within the CMS parameters that could reflect meaningful health outcomes for our population and maximize our opportunity to experience shared savings. We have attached a copy of our submission to CMS on the Shared Savings quality measures and it is also posted to our TennCare website. This document provides additional details on each of the measures and shared savings. While TennCare has achieved and maintained high performances across several measures in the full Adult and Child Core set, we are always committed to opportunities that can help to further improve the health of our members. We would welcome any suggestions or ideas that may further help us improve the quality of care being provided to our members, especially in these Shared Savings quality measures.

Thank you for your partnership and your service to the TennCare program.

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