Looking 'AHEAD': CMS rolls out ambitious new primary care program for 8 states

The Centers for Medicare & Medicaid Services has announced a total cost-of-care reduction model designed to give state governments tools to reduce spending and increase quality. The program will be available in eight selected states, and each may get up to $12 million in implementation funding.

The States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model focuses on strengthening primary care, enhancing care coordination for those on Medicare and Medicaid plans, and increasing screening for referral to community resources. Participating primary care practices will be required to engage in behavioral health integration activities.

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

All 50 states, Washington, D.C. and territories with at least 10,000 Medicare beneficiaries are eligible to apply to participate in AHEAD. CMS expects to notify states in Spring 2024.

According to CMS, the AHEAD model (see CMS fact sheet) will:

• Focus resources and investment on primary care services, giving primary care practices the ability to improve care management and better address chronic disease, behavioral health and other conditions.
• Provide hospitals with a prospective payment stream through hospital global budgets, while including incentives to improve beneficiaries’ population health and equity outcomes.
• Address health-care disparities through stronger coordination across health care providers, payers and community organizations in participating states or regions.
• Address the needs of individuals with Medicare and/or Medicaid by increased screening and referrals to community resources such as housing and transportation.

Related: Primary care doctor shortage: Are we reaching a tipping point?

“Primary care is the foundation of a high-performing health system and essential to improving health outcomes for patients and lowering health-care costs,” said Liz Fowler, deputy CMS administrator and Innovation Center director. ”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. Through AHEAD, more states will have the exciting opportunity to improve the overall health of their population, support primary care and transform health care in their communities.”

CMS will release more information about the funding opportunities later this fall, with an application period next spring. The funding and programs will have three cohorts with various start dates, implementation and planning periods. Each will start in January 2026 or January 2027. The model concludes in December 2034.