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Episodes of Care

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

 

EOC risk neutrality factors

 

EOC reconsideration form

 

EOC contact information

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