The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model, a state total cost of care model that Maryland, Connecticut, Hawaii, Vermont, Rhode Island and Downstate New York will participate in.

While certain changes affect state requirements, key changes affecting hospitals and providers include:

• A New Geographic-Based Accountable Care Organization Program (Geo AHEAD):
  • Two-sided risk model that engages otherwise unattributed Medicare beneficiaries
  • Hospitals participating in AHEAD global budgets and providers opting into the Primary Care AHEAD model can participate as a Geo AHEAD or join a Geo AHEAD controlled and led by non-provider organizations – a major shift from traditional provider-led models.
  • Geo AHEAD will run in two 4-year phases (2028–2031, 2032–2035).

• Model Timeline: CMS extended the end date of the model from 12/31/34 to 12/31/35.
• Health Equity Plans Replaced: New Population Health Accountability Plans will focus on preventive care, including chronic disease prevention.
• CMS Released Maryland’s PC AHEAD Attribution and Payment Methodology: Eligible primary care providers (including FQHCs/RHCs) participating in state Medicaid or PCMH programs can earn an Enhanced Primary Care Payment, averaging around $21 and paid quarterly on top of regular fee-for-service billing. The EPCP will be adjusted for quality performance, initially 5% of PMPM and growing to 10% in 2035. Attribution is calculated prospectively on a quarterly basis based on plurality of primary care visits.

Considerations for Hospitals/IPAs/CINs/ACOs:

• Continue to consider how to leverage global budget required capabilities and infrastructure to succeed in broader risk arrangements.
  • Strongly consider developing IPA/CIN infrastructure aligned around a network configuration strategy that focuses on coordinating primary care with an ambulatory network of specialists, both for employed and voluntary providers in the communities that hospitals serve.
• Continue to consider overlapping opportunities with other CMS value-based payment (VBP) models.
  • The AHEAD model’s flexible attribution and its overlap with Medicare Shared Savings Program (MSSP) and REACH enable organizations to strategically align participation across models, including mandatory participation in the Transforming Episode Accountability Model (TEAM).
• Leverage PC AHEAD enhanced payments to strengthen care delivery and payment models for hospital-affiliated primary care practices.

COPE Health Solutions can assist your organization with:

• Strategic Planning & Design:
  • Expert team, templates and tools to develop a roadmap to enable success in both global budget and remaining VBP agreements, including MSSP ACO and ACO REACH.
  • Gap assessment for global budgets and MCO value-based payment.
  • Financial modeling for global budget and pro forma for global budget, PC AHEAD, MSSP, ACO REACH and VBP agreements to optimize revenue and understand scenario impacts of attribution differences and overlaps between models.
• Network and Care Model Configuration and Ongoing Management for Attributed Population: Development and coordination of a highly coordinated primary care network, including expansion of panels and locations.

• Optimized Data Driven Care Model: Complex CM, disease management, care coordination, care transitions that align with global budget and PC AHEAD care transformation requirements.

• Launching and Succeeding in MSSP/ACO REACH in Conjunction with AHEAD: Launch and grow independent Medicare ACOs, transition from shared savings conveners and build internal infrastructure to sustain performance.
• Analytics for Risk Contracting (ARC): Comprehensive population health management platform to enable parallel success with global budget, other VBP agreements and MSSP ACOs, including integration with EMR, local HIE/QE and closed loop referral platform.

Now is the time to plan. With the changes going live in 2026, primary care organizations, ACOs and state-level stakeholders should begin assessing alignment opportunities, data infrastructure needs and partner participation strategies.

Please reference CHS’ AHEAD model webpage and previous articles for more background information on the AHEAD model.

If you are interested in learning more about AHEAD, please reach out to info@copehealthsolutions.com to learn how CHS can help your organization succeed in AHEAD or any other form of value based payment for Medicare, Medicaid or commercial lines of business.