CMS unveils AHEAD Model to transform healthcare

In an effort towards improving the overall health and equity of healthcare delivery across the United States, the Centers for Medicare & Medicaid Services (CMS) has announced a groundbreaking initiative to empower states to redesign healthcare delivery. Named the States Advancing All-Payer Health Equity Approaches and Development Model, or the “AHEAD Model,” This transformative approach seeks to enhance and change the management of healthcare at the state level, focusing on efficiency, high-quality care, and coordination among healthcare providers to address chronic diseases, behavioral health issues, and other medical conditions. 

AHEAD Model: A Path to Health Equity

The AHEAD Model signifies the evolution of CMS’s commitmenet to multi-payer total cost of care models. Participating states will lead the charge in embracing a holistic healthcare approach, with a mission to boost care quality, promote health equity, expand access to primary care services, and manage healthcare expenditures while reducing costs for patients. 

Key Objectives of the AHEAD Model:

• Enhancing quality and efficacy: States joining the AHEAD Model will assume responsibility for achieving top-tier care quality and enhancing population health outcomes. The primary focus is on delivering effective care that secures better health results for all individuals. 
• Reducing health disparities: The AHEAD Model seeks to address persistent health disparities among marginalized communities. It will facilitate more robust collaboration among healthcare providers, payers, and community organizations to bridge these disparities. 
• Improving health outcomes: By fortifying primary care, streamlining care coordination, and expanding healthcare access, the AHEAD Model aims to elevate overall health outcomes for individuals covered by Medicare and Medicaid. 

• Tackling social determinants of health: Acknowledging the vital role of social determinants in health, the AHEAD Model encourages increased screening and referrals to community resources such as housing and transportation to comprehensively meet patients’ needs. 

“In our current health care system, fragmented care contributes to persistent, widening health disparities in underserved populations,” said CMS Administrator Chiquita Brooks-LaSure in the press release. “The AHEAD Model is a critical step towards addressing disparities in both health care and health equity while improving overall population health.”  

Investing in Primary Care and Health Equity

The AHEAD Model is set to bring transformative change to the healthcare landscape through its emphasis on: 

• Primary care services: By bolstering investment in primary care services, the AHEAD Model empowers primary care providers to better manage care and address chronic ailments and behavioral health conditions. 
• Hospital global budgets: Participating hospitals will receive a predetermined payment stream via hospital global budgets, along with incentives to enhance population health and equity outcomes for beneficiaries. 
• Multi-Payer primary care transformation: States will collaborate with primary care providers to participate in a multi-payer primary care transformation, including increased investments by Traditional Medicare and an advanced primary care program coordinated between Medicaid and Traditional Medicare. 
• All-payer cost growth targets: States will establish all-payer cost growth targets to incentivize efforts to curb healthcare cost escalation while fostering transformative change. 
• Medicare and all-payer primary care investment: Participating states will have targets to bolster primary care delivery, ensuring robust support for primary care services. 

“Primary care is the foundation of a high-performing health system and essential to improving health outcomes for patients and lowering health care costs. For that reason, the CMS Innovation Center has invested significant time and resources over the years testing models to strengthen primary care and improve care coordination and linkages to organizations that address health-related social needs,” said Deputy CMS Administrator and Innovation Center Director Liz Fowler. “Through AHEAD, more states will have the exciting opportunity to both improve the overall health of their population, support primary care, and transform health care in their communities.” 

The AHEAD Model draws inspiration from successful state-based models such as the Maryland Total Cost of Care Model, the Vermont All-Payer ACO Model, and the Pennsylvania Rural Health Model. It builds upon these foundations and offers additional states the opportunity to reduce healthcare costs, enhance population health, and advance health equity. 

By addressing health disparities, increasing access to primary care, and investing in innovative approaches, the AHEAD Model holds the potential to significantly improve the healthcare landscape in the United States. It is currently scheduled to operate for 11 years, from 2024 to 2034.