November 14, 2024  – The Centers for Medicare & Medicaid Services (CMS) has recently expanded its States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model to include Rhode Island and specific counties in New York. This addition marks a significant extension of an initiative aimed at transforming health care delivery and payment structures across the United States.

The AHEAD Model, which commenced in the summer of 2024, is set to continue until December 2034. It represents a long-term commitment by CMS to partner with states in overhauling their healthcare systems to achieve more sustainable cost structures and improved health outcomes. This innovative model encourages states to implement global hospital budgets, enhance primary care, and hold themselves accountable for the growth of healthcare spending on a regional or statewide basis.

Under the AHEAD Model, each participating state is granted a cooperative agreement with the potential to receive up to $12 million in the initial five to six years. These funds are intended to support the states as they implement and refine their health care strategies in alignment with the model’s objectives.

The model now includes Rhode Island and the New York counties of Bronx, Kings, Queens, Richmond, and Westchester, each chosen based on their readiness to engage in this transformative healthcare initiative. Eligibility for the model required that states or regions have at least 10,000 Medicare fee-for-service beneficiaries, ensuring a sufficient impact scale.

State Responsibilities and Cohort Scheduling

States participating in the AHEAD Model are tasked with collaborating closely with CMS to set and achieve specific targets for cost containment, quality improvement, and health equity. These goals are to be met not only for Medicare beneficiaries but across all payer systems, including state Medicaid programs. Hospitals within these states are expected to adhere to strict performance measures and manage annual Medicare budgets comprehensively. Primary care providers are also pivotal, expected to meet rigorous quality measures and participate actively in state-led Medicaid transformation efforts.

The model is structured in cohorts to allow phased implementation:

• Cohort 1, comprising Maryland and Vermont, began an 18-month pre-implementation phase in July 2024, leading up to a performance period starting in January 2026.
• Cohort 2, including Connecticut and Hawai’i, started a 30-month pre-implementation phase at the same time, with their performance period set to commence in January 2027.
• Cohort 3, now including New York and Rhode Island, will enter a 24-month pre-implementation period starting in January 2025, with performance measures effective from January 2027.

Future Projections and Impact

The expansion of the AHEAD Model to include six states reflects CMS’s commitment to fostering innovative health care solutions that emphasize equity, quality, and fiscal responsibility. By aligning state health agencies, hospitals, and primary care providers towards common goals, CMS aims to craft a more efficient and equitable healthcare system. This approach not only targets immediate improvements but also sets the foundation for sustainable health practices that could serve as a model for future federal and state healthcare reforms.

For further details on the AHEAD Model’s framework and participant responsibilities, click here to visit the official CMS website or consult relevant notices in the Federal Register.