What is the Centers for Medicare and Medicaid Services’ New AHEAD Model?

(By Alice Burns for The Kaiser Family Foundation Published: Jan 02, 2024)

In September 2023, the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to leverage federal funding on health care: the Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. With this model, CMS–under the auspices of the CMS Innovation Center, also known as CMMI–aims to reduce the rate of growth in health care spending, improve people’s health, and reduce disparities in health outcomes. To achieve those broad aims, state demonstration programs will involve multiple programs and strategies, but the key feature of the model is prospective lump sum payments to participating hospitals that cover the costs of providing all inpatient and outpatient care to a pre-defined patient population. The lump sum payments would cover Medicaid enrollees, certain Medicare beneficiaries, and people who are covered by one or more private payers. Up to eight participating states would also be eligible for a planning grant of up to $12 million each to design and implement the model. This issue brief answers some key questions about the new model and explores considerations for potential state and private participants. Continue reading here…

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