States Advancing All-Payer Health Equity Approaches and Development - AHEAD
AHEAD is a CMS voluntary total cost of care model that fosters collaboration with states to increase investment in primary care, improve overall population health, advance health equity, and curb the growth of health care costs.
Three key components of the model are:
- Cooperative Agreement Funding
- Eight states, or sub-regions of states, will be awarded up to $12 million to support planning and implementation including setting all-payer cost growth targets. The AHEAD model is scheduled to operate for a total of 11 years, from 2024 – 2034
- Hospital Global Budgets
- Hospitals may voluntarily participate in a global budget, which is a pre-determined, fixed annual budget set prospectively for hospital inpatient and outpatient facility services
- Global budgets will be calculated based on historical revenues and adjusted annually based on market dynamics, demographic shifts, and other AHEAD-specific and performance-based adjustments
- Medicare FFS, Medicaid, and at least one MA/commercial payer are required to participate
- Primary Care AHEAD
- Primary care practices, FQHCs, and RHCs that are located within a participant state or sub-state region and are participating in the state’s Medicaid Primary Care Alternative Payment Model (APM) are eligible.
- Participating practices will receive Enhanced Primary Care Payments (EPCP), which will average $17PBPM (adjusted between $15-$21) for attributed beneficiaries.
- These practices will be required to meet care transformation requirements targeting behavioral health integration, care coordination, and health-related social needs (HRSN)
How we enable success in AHEAD:
- Strategic Planning & Design
- Strategic alignment – AHEAD requirements review, strategic vision-setting and operational plan
- Gap assessment for global budgets and MCO value-based payment
- Financial modeling for global budget and pro forma for global budget and VBP agreements to optimize revenue and understand scenario impacts
- ARC comprehensive population health management platform to enable parallel success with Global Budget and remaining VBP agreements, including MSSP ACOs, including integration with EMR, local HIE/QE and closed loop referral platform
- Financial modeling for global budget and pro forma for global budget and VBP agreements to optimize revenue and understand scenario impacts
- Current payer contract analysis and proposed term sheets related to revenue enhancement and delegation during the 2-3 years prior to global budget and for non global budget impacted lines of business
- Expert team, templates and tools to develop the required “custom roadmap” in such a way as to enable success in both Global Budget and remaining VBP agreements, including MSSP ACO
- Expertise in value based contracting and operations enabling alignment of VBP models across professional and institutional risk pools to create win-win financial and operational relationships with local risk-bearing IPAs and ACOs
- Implementation
- Management of VBP roadmap execution and gap closure including CIN/IPA optimization, care model, analytics
- Development and coordination of a highly coordinated IPA/CIN primary care network and care model that aligns with AHEAD care transformation requirements
- Optimize contractual, operational and financial alignment with market IPAs and ACOs
- Optimized data driven care model (complex CM, disease mngt, care coordination, care transitions)
- Grow primary care empanelment
- Health equity plan design and implementation (both AHEAD and NY Waiver requirement)
- Ongoing Operations
- Population health analytics, closed referral, and care management workflow platforms
- Co-management of IPA/CIN and hospital global budget “MSO” option – toolkits, templates, platforms, and workflows configured for success in Medicaid, Medicare and Commercial global budgeting and MCO value-based payment
