TennCare - health system reform for Tennessee

Article Abstract:

TennCare, the innovative Tennessee health care reform program instituted in January 1994, has experienced major financial problems. TennCare was developed to control the rising costs of the state's Medicaid program and to cover the uninsured. By using state-chartered managed care organizations (MCOs), TennCare was expected to reduce health care expenditures for both the state and federal governments, however, the program has a $99 million deficit after one year. Several assumptions and comparisons with previous health care programs made by designers of the TennCare program proved to be inaccurate. The state underestimated the previous costs of Medicaid. TennCare, which covers 25% of the state's nearly 5 million residents, provides a wider array of services than Medicaid and has improved access to services, both of which have increased usage. TennCare enrollees may have been sicker than the state employee group or enrollees in other health maintenance organizations. The state did not send premium booklets to 80,000 enrollees expected to contribute monthly premiums.

Health care reform

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Tennessee's failed managed care program for mental health and substance abuse services

Article Abstract:

Tennessee's TennCare Partners program illustrates the problems that can occur when states contract with managed care organizations to provide mental health services. The program is a separate part of the TennCare plan, which enrolled all Medicaid recipients in managed care programs. TennCare Partners contracts all services for severe mental illness to private behavioral health organizations. However, this reduces accountability, introduces another layer of bureaucracy and spreads the risk over the entire Medicaid population. Other states contemplating similar programs can learn from these mistakes.

Finance, Psychiatric services, Mental health services, Science and technology policy

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Academic Managed Care Organizations and Adverse Selection Under Medicaid Managed Care in Tennessee

Article Abstract:

Academic medical centers may attract the sickest patients, which could present a problem if the center is part of a managed care organization (MCO). Academic medical centers are hospitals that are associated with a medical school. Researchers analyzed the number of patients who had one of 33 high-cost chronic medical conditions at academic MCOs compared to other MCOs. For most of the 33 chronic diseases, the number of patients with that disease was higher in academic MCOs than in other MCOs. For example, the number of AIDS patients at academic MCOs was 14 times higher than in other MCOs.

Statistical Data Included, Economic aspects, Chronic diseases, Hospitals, University, University hospitals

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