Failed promises: the demise of the original TennCare vision

Managed care was the intended foundation of Tennessee's Medicaid-replacement program (TennCare) when it was implemented in 1994. By the Summer of 2005, however, when the mandated disenrollment of approximately 200,000 adult TennCare beneficiaries commenced, it was obvious that the promise of managed care had not been realized. The program collapsed under the weight of mismanagement and unrealistic expectations. Whether the demise of the original TennCare vision was the result of fundamental design flaws in the concept of managed care or poor execution of that concept are questions that remain unanswered, subsumed in the aftermath of pervasive failures and disillusionment. This paper identifies lessons learned from the TennCare program.