States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

Three key components of the model are:

1. 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
2. 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
   • Medicare FFS, Medicaid, and at least one MA/commercial payer are required to participate
3. 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.
   • b. Participating practices will receive Enhanced Primary Care Payments (EPCP), which will average $17PBPM (adjusted between $15-$21) for attributed beneficiaries.

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
• 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
• 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 a roadmap 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 global budget VBP roadmap execution and gap closure including Global Budget and CIN/IPA/ACO optimization, care model, analytics
  • Development and coordination of a highly coordinated primary care network, including expansion of panels and locations, 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)
  • 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 hospital global budget and any IPA/CIN/ACO “MSO” including toolkits, templates, platforms, and workflows configured for success in Medicaid, Medicare and Commercial global budgeting and MCO value-based payment

Thought Leadership

Key Considerations for AHEAD

5 Things for Health Systems in Potential Participating States to Know About the AHEAD Program

Medicaid Global Budgets for Downstate New York Safety Net Hospitals