Tennessee Patient-Centered Medical Home Integrates Primary and Behavioral Care, Improving Costs and Outcomes

When 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 the 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. The agency partnered with leading global consultancy Guidehouse on a three-year engagement to execute its primary care and behavioral health transformation strategy.

The initiative included designing and implementing a patient-centered medical home (PCMH), enhancing care coordination for TennCare members with the greatest behavioral health needs, and developing a web-based care coordination tool. Guidehouse worked closely with TennCare, its three health plans, and the PCMH and THL practices to ensure 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.”

Additional results achieved through the partnership include nearly 350 practice sites with NCQA PCMH recognition and $23 million in performance bonus payments for PCMH and THL providers.

“Within three years, our work in integrating behavioral health with primary care services led to a 3% reduction in total cost of care for Medicaid patients and an 11% decrease in inpatient hospital admissions.”