CMS announces transformative model to give states incentives and flexibilities to redesign healthcare delivery, improve equitable access to care
The Centers for Medicare & Medicaid Services (CMS) unveiled a step to test a state’s ability to improve the overall healthcare management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients.
States participating in AHEAD will be accountable for quality and population health outcomes, while reducing all-payer avoidable healthcare spending to spur statewide and regional healthcare transformation.
Through this new voluntary Model, CMS will partner with states to redesign statewide and regionwide healthcare delivery to improve the total population health of a participating state or region by improving the quality and efficacy of care delivery, reducing health disparities, and improving health outcomes. AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve Model goals. Through AHEAD, CMS aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources like housing and transportation to address social drivers of health.
CMS will issue awards to up to eight states. Each state selected to participate in the AHEAD Model will have an opportunity to receive up to $12 million from CMS to support state implementation. Recognizing that some states are more ready than others to implement change, states interested in participating in the model may apply during two different application periods and elect to participate in one of three cohorts with staggered start dates and performance years.
The Notice of Funding Opportunity (NOFO), which includes the specific application requirements, will be released in late fall 2023. States will have 90 calendar days to apply for a cooperative agreement award during this first application period. The second NOFO application period is anticipated to open in Spring 2024 with a 60-day application period. States must apply to the NOFO during the application period to participate in the AHEAD Model. For additional information on the NOFO application timeline, please refer to the model website. The pre-implementation period is scheduled to begin for the first cohort in summer 2024. The model performance period for states is scheduled to begin in January 2026 or January 2027, depending on the cohort, and the model will conclude for all state participants in December 2034. CMS is offering a longer pre-implementation, or planning period, for states that need additional time to prepare for the care redesign required under the Model. CMS is also testing this Model over a longer period to allow time for early investments in primary care services and enhanced care coordination to result in better health and lower spending.
