CMS Rolls Out State-Based Model For Chronic Disease Management

The Centers for Medicare and Medicaid Services (CMS) is working in collaboration with individual states  to improve the manner in which healthcare is provided in regional settings. This will be done through the AHEAD Model, (which stands for the States Advancing All-Payer Health Equity Approaches and Development Model).

As stated in a press release, each of the states involved will experience enhanced accessibility to primary care services, and their expenditure will be directed towards achieving a more enduring financial course. As a result of the model’s incorporation of primary care clinic and hospital funding streams, it is expected that patients will have easier access to more diagnostic tests and referrals to community organizations like those providing homes and transportation.

More Benefits of the AHEAD Model:

Some other advantages of the model are:

• There will be the typical payments made by Medicare and Medicaid.
• Health insurers will pay a predetermined amount of money to member hospitals.
• Primary care providers will have the ability to offer care administration services and participate in the program. 
• Reduced healthcare expenses for individuals. 

CMS will evaluate these providers for future payments based on their performance on quality metrics, their ability to integrate mental health services, and their capacity to address socioeconomic factors that influence health.

To put the concept into action, CMS will provide up to $12 million to eight specific states. Due to the possibility that certain states are more prepared to put the plan into action than others, there are three distinct cohorts available. The prerequisites for applications will be made public around the end of the fall. Some states will have access to pre-implementation features, and others will begin participating in the AHEAD Model as early as January 2026 and continue through December 2034.

New modifications to the ACO REACH Model were announced by CMS in August. These modifications included lowering the beneficiary alignment requirement for entrant ACOs and widening the criteria to encompass a greater number of beneficiaries.

The AHEAD Model does not take into account the possibility of a two-way integration of primary care and mental health services. This represents a significant element of the strategic objectives formulated by the Substance Abuse and Mental Health Services Administration (SAMHSA) and publicly disclosed in August.

Late in 2023, CMS will make available further data about the funding opportunities and there will be an application process beginning in the spring of that same year.