New CMMI Model Supports Health Equity in States, Shifts Care to the Community

CMS has unveiled a new payment model aiming to support health equity in the states by shifting health care to community-based settings. The agency is already addressing health equity in other models, such as Enhancing Oncology Model and ACO REACH.

The States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) aims to better address chronic disease, behavioral health, and other medical conditions by equipping states to promote health equity, increase access to primary care, encourage more sustainable health care spending, and lower costs for patients.

The new AHEAD Model aims to support health equity in states by shifting care to community-based settings, promoting primary care, and increase screening and referrals to resources to address social determinants of health.

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

AHEAD is the next iteration of CMMI multipayer total cost of care models. States that participate will be accountable for quality and health outcomes while reducing avoidable care spending.

Through the model, CMS partners with states to redesign statewide and regionwide health care delivery with the goal of enhancing total population health. The model includes payment models for participating hospitals and primary care practices to achieve the goals of the model.

Through AHEAD, CMS is looking to not only strengthen primary care and improve care coordination, but also increase screening and referrals to resources that help address social determinants of health, such as housing and transportation.

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

Up to 8 states will be selected to participate in the AHEAD Model and each will have the opportunity to receive up to $12 million from the agency.

In late fall 2023, CMS expects to release a Notice of Funding Opportunity followed by an application period in Spring 2024. States interested in participating in the mode will have to apply during these 2 application periods.

Applying states will select 1 of 3 cohorts:

• Cohort 1: 18-month pre-implementation period tentatively starting July 2024 for states ready to apply and implement AHEAD as soon as possible. The first performance year (PY) will tentatively begin January 2026 with 9 PYs.
• Cohort 2: 30-month pre-implementation period tentatively starting July 2024 for states that need additional time to prepare for implementation. This time may be used for activities such as developing Medicaid components, recruiting providers to participate, and developing data infrastructure. The PY will tentatively begin January 2027 with a total of 8 PYs.
• Cohort 3: 24-month pre-implementation period tentatively starting January 2025 for states that need additional time to apply to the model. The first PY will tentatively begin January 2027 with a total of 8 PYs.

Overall, the AHEAD Model will operate for 11 years from 2024 through 2034. According to CMS, the model will build upon the work of state-based models from CMMI such as the Maryland Total Cost of Care Model, the Pennsylvania Rural Health Model, and the Vermont All-Payer Accountable Care Organization Model.