Background
AHEAD builds on prior state-based models like the Vermont All-Payer Accountable Care Organization (VT ACO) Model and the Maryland Total Cost of Care Model (MD TCOC), while expanding to multiple states concurrently.
Model Aims
AHEAD supports sustained primary care investment and coordinated population health improvements statewide or regionally to:
- Curb the growth of health care costs across all payers while maintaining or improving quality
- Strengthen primary care through increased, predictable investment and care management supports
- Improve population health by enhancing preventive care statewide and addressing whole person needs
- Align Medicaid and commercial payers with Medicare to reduce fragmentation and administrative burden
Innovation
AHEAD helps bring total cost of care accountability to all Original Medicare beneficiaries in participating states and regions. In exchange for assuming two-sided risk arrangements, state and regional participants receive tools and enhanced flexibilities to improve health outcomes and lower spending for their patients. Patients may receive additional beneficiary incentives while enjoying existing protections under the Original Medicare program.
Design
The AHEAD Model consists of four primary components to assist states in meeting their Total Cost of Care (TCOC) and quality targets:
- Cooperative Agreement Funding: CMS will provide cooperative agreement funding for states to invest in planning activities that support model goals during the pre-implementation period and initial performance years. This period will be critical to the model’s success and will require significant effort from the state and its partners, particularly in implementing the Medicaid methodologies to align with the key Medicare components of the model.
- Primary Care AHEAD (PC AHEAD): Primary care practices located in a participating state or sub-state region will have the option to participate in PC AHEAD, to advance ongoing local Medicaid transformation efforts and increase Medicare investment in primary care. Participating practices receive prospective, risk-adjusted Enhanced Primary Care Payment based on the medical and social complexity of their patient populations, along with quality-based adjustments, and can choose from four payment pathways, including two offering prospective payments in lieu of part or all of corresponding Medicare Fee-for-Service payments. This structure supports the delivery of person-centered, coordinated care and encourages continuous improvement in population health.
- Hospital Global Budgets (HGBs): Global budgets provide hospitals with a predictable amount of revenue for the upcoming year for a specific patient population or program, such as Medicare fee-for-service beneficiaries. A global budget encourages hospitals to eliminate avoidable hospitalizations and improve care coordination between hospitals, primary care providers, and specialists.
- Geo AHEAD: Geo AHEAD uses competitive bidding to select multiple Geo Entities within each participating state or sub-state region, ensuring beneficiary choice and promoting market competition. Geo Entities are accountable for total cost of care (TCOC) and quality outcomes for attributed beneficiaries, who may be aligned through voluntary selection, claims-based attribution, or geographic assignment.
The policy and operational changes to the AHEAD Model, as well as the updated model timeline announced in 2025 will help states achieve their total cost of care (TCOC) targets, while advancing the Center’s commitment to promote choice and competition, increase prevention, empower patients, and protect taxpayer dollars.
