CMS has released more information about the new population health-focused payment model it is launching aimed at addressing chronic disease, behavioral health and overall improvement of care management for states' populations.
CMS announced the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model in September. It said it would award as many as eight states up to $12 million each to implement the model. States participating in the AHEAD model will be accountable for quality and population health outcomes, along with reducing avoidable spending. Participants will partner with providers and leverage existing relationships to recruit hospitals — participating hospitals will receive an annual fixed payment.
The agency on Feb. 12 released financial specifications for the hospital global budget methodology for Medicare fee-for-service patients under the model.
CMS said in the document that hospital global budgets are a key component of the AHEAD model and "provide incentives to change the care delivery model, improve quality and advance health equity, reduce unnecessary utilization, and reduce cost growth."
Hospitals that voluntarily agree to participate under a hospital global budget will sign hospital participation agreements with CMS that will "enumerate their participation requirements and expectations," according to the report. These agreements will be provided to interested hospitals during the pre-implementation period and will need to be signed in advance of a hospital participating in hospital global budgets for the upcoming performance year.
CMS said that by participating in hospital global budgets and shifting away from fee-for-service incentives, "hospitals realize financial savings from reduced avoidable utilization (e.g., avoidable admissions and emergency visits) and moving care to lower acuity settings, when appropriate." Hospitals also "derive value from stable and predictable funding, the ability to reorient activities to population health management, and the opportunity to deploy innovative strategies that improve beneficiary care quality and reinvigorate clinician engagement."
CMS also released a fact sheet Feb. 14 detailing how the AHEAD model interacts with the agency's other payment models.
The following models and programs can concurrently operate within an AHEAD state or sub-state region, with certain conditions and restrictions:
- ACO REACH
- Guiding an Improved Dementia Experience
- Primary Care First
- Innovation in Behavioral Health
- Medicare Shared Savings Programs
The following models cannot concurrently operate within the participating AHEAD state or sub-state region:
- Making Care Primary
- Transforming Maternal Health