On October 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced the latest states to participate in the voluntary state total cost of care (“TCOC”) model: the All-Payer Health Equity Approaches and Development (“AHEAD”) Model. The initiative aims to curb healthcare costs and improve population health by allowing states to assume responsibility for their own healthcare systems. Specifically, the program holds states accountable for meeting state-specific Medicare targets, reducing cost growth, primary care investment, and advancing health equity principles.
As of August 2024, Maryland, Vermont, Connecticut, Hawai’i, Rhode Island, and five downstate counties of New York have been selected to implement AHEAD. Program Overview In September 2023, CMS unveiled AHEAD, a new, voluntary state TCOC model that seeks to drive transformation of the health care system on state and regional levels by incentivizing multi-payer alignment. AHEAD builds on existing, successful state-based models including, Vermont All-Payer Accountable Care Organization (VT ACO) Model , the Maryland Total Cost of Care Model (MD TCOC) , and the Pennsylvania Rural Health Model (PARHM) .
With the implementation of AHEAD, CMS will be able to expand this state-based TCOC into multiple states at once. Under the AHEAD model, participating states uses their authority to assume responsibility for managing health care quality and costs within their respective health care systems by impro.
