Delivery system transformation programs
Episode-based payment seeks to align provider incentives with successfully achieving a patient's desired outcome during an “episode of care,” which is acute or specialist-driven health care delivered during a specified time period to treat a physical or behavioral condition. Episodes reward high-quality care, promote the use of clinical pathways and evidence-based guidelines, encourage coordination, and reduce ineffective and/or inappropriate care. Episode-based payment is applicable for most procedures, hospitalizations, acute outpatient care (e.g., broken bones), as well as some forms of treatment for chronic (e.g., cancer) and behavioral health conditions (e.g., ADHD).
For more information about Episodes of Care, please visit TN.gov.
Episodes of Care Program resources
EOC Payment Appendix threshold updates
EOC risk methodology documents
- UnitedHealthcare 2022 Episode of Care Risk Methodology Description Wave 1
- UnitedHealthcare 2022 Episode of Care Risk Methodology Description Wave 2
- UnitedHealthcare 2023 Episode of Care Risk Methodology Description Wave 3
- UnitedHealthcare 2024 Episode of Care Risk Methodology Description Wave 4
- UnitedHealthcare 2023 Episode of Care Risk Methodology Description Wave 5
- UnitedHealthcare 2024 Episode of Care Risk Methodology Description Wave 6
- UnitedHealthcare 2024 Episode of Care Risk Methodology Description Wave 7
- UnitedHealthcare 2024 Episode of Care Risk Methodology Description Wave 8
- UnitedHealthcare 2024 Episode of Care Risk Methodology Description Wave 9
EOC reconsideration form
Journey Program resources
EOC and Journey Program contact information
- UnitedHealthcare EOC/Journey Team - se_government_programs@uhc.com
- TennCare - payment.reform@tn.gov
Patient-Centered Medical Homes (PCMH) are a comprehensive care delivery model designed to improve the quality of primary care services for TennCare members, the capabilities of and practice standards of primary care providers, and the overall value of health care delivered to the TennCare population.
For more information about the PCMH program, please visit TN.gov.
Patient-Centered Medical Home resources
Program contact information
- UnitedHealthcare PCMH Team - tnpcmh@uhc.com
The primary objective of Tennessee Health Link is to coordinate health care services for TennCare members with the highest behavioral health needs. Health Link providers commit to providing comprehensive care management, care coordination, referrals to social supports, member and family support, transitional care, health promotion, and population health management.
For more information about the Tennessee Health Link (THL) Program, please visit TN.gov.
Tennessee Health Link resources
Program contact information
UnitedHealthcare THL Team - bh_payment_reform@uhc.com