The Centers for Medicare & Medicaid Services (CMS) has introduced a significant initiative to evaluate a state’s capability to enhance the overall health care management of its residents. The program, named the States Advancing All-Payer Health Equity Approaches and Development Model (or “States Advancing AHEAD” or “AHEAD Model”), is designed to more effectively tackle chronic illnesses, behavioral health issues, and other medical conditions. With the AHEAD Model, states that participate will be better positioned to foster health equity, expand access to primary care services, establish health care spending on a more sustainable path, and reduce health care expenses for patients.
The AHEAD Model is the subsequent phase of the CMS Innovation Center’s multi-payer total cost of care models. States that join AHEAD will be responsible for the quality and health outcomes of the population, while also minimizing all-payer avoidable health care expenses to stimulate statewide and regional health care transformation. This new voluntary model will see CMS collaborating with states to overhaul statewide and regional health care delivery to enhance the total health of the population of a participating state or region. This includes elevating the quality and effectiveness of care delivery, diminishing health disparities, and ameliorating health outcomes. The AHEAD initiative also encompasses distinct payment models for hospitals and primary care practices to achieve the objectives of the model. Through this initiative, CMS aims to fortify primary care, enhance care coordination for Medicare and Medicaid beneficiaries, and augment screenings and referrals to community resources like housing and transportation to tackle the social determinants of health.