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AHEAD

Achieving Healthcare Efficiency through Accountable Design

AHEAD is a voluntary state total cost of care (TCOC) model that aims to drive state and sub-state-regional health care transformation and multi-payer alignment. It seeks to improve the total health of a state’s population while lowering costs by investing in primary care, implementing hospital global budgets, and utilizing geographic ACO entities.

Active since 2026-01-01

Innovation

AHEAD introduces Population Health Accountability Plans (PHAP), capitated pathways in Primary Care AHEAD, and Geo AHEAD—a two-sided risk ACO program incorporating geographic alignment and bids against a discounted benchmark where ownership is not required to be provider-led.

The Problem

Rising health care costs, uneven investment in primary care, and inconsistent quality of care at the state level contribute to poor patient outcomes.

The Solution

Investing in primary care, hospital global budgets, geographic ACO entities, with multi-payer alignment and shared cost and quality targets can stabilize funding, expand primary care services, and improve population health.

Expected Outcomes

AHEAD’s goal is to improve the overall health of a state’s population and support a sustainable health care budget.

Strategy

AHEAD gives participating states, geographic ACO entities, primary care providers, and hospitals tools to better manage and lower Medicare and Medicaid costs thus protecting taxpayers and tools to improve quality of care and population health outcomes. Aspects of AHEAD model design also advance the strategic pillars of choice and competition and prevention.

Model Goals

  • Improve the overall health of a state’s population
  • Support a sustainable health care budget
  • Curb growth in health care spending
  • Increase statewide primary care investment in proportion to the total cost of care

Patient Eligibility

Medicare FFS beneficiaries residing in the participating state or sub-state region who meet specific eligibility criteria.

  • Residents in the state for a minimum defined period
  • Attributed Medicare Part B beneficiaries for Primary Care AHEAD

Provider Eligibility

Hospitals must be Medicare-enrolled facilities in good standing. Primary care practices must participate simultaneously in the state Medicaid advanced primary care program or PCMH program.

  • Must be a Medicare-enrolled facility in good standing with CMS
  • Primary care practices must participate simultaneously in the state Medicaid advanced primary care program or PCMH program
  • Health system-owned practices may only participate in Primary Care AHEAD if the health system’s hospitals are participating in the hospital global budgets (FQHCs and RHCs exempted)

Care Categories

Primary Care

Advanced primary careCare coordinationBehavioral health integrationHealth-related social needs interventions

Acute Care

Inpatient hospital servicesOutpatient hospital services

CMS Benchmarks & Thresholds

financial

Acute Care Hospitals TCOC Upside Risk Start Performance Year4
Hospital Global Budget NPR Minimum (Initial)0.1%
Hospital Global Budget NPR Minimum (Year 4)0.3%
Minimum Commercial Payers in HGB (PY2)1
Cooperative Agreement Funding Duration (Cohorts 1 & 2)5.5
CAH TCOC Downside Risk Start Performance Year4
HGB Baseline Weight Base Year 30.6%
CAH HGB Payment Floor Percent of Costs1.01%

operational

Minimum Choice Policies to Implement1
Geo AHEAD Contract Period Duration4
Medicaid HGB Implementation Performance Year1
Policy Change Announcement Date2025-09-03
Cohorts 2 and 3 Performance Start Date2028-01-01
Model End Date for All Cohorts2035-12-31
Policy Change Implementation Start Date2026-01-01
New States Join Date2026-07-01
New States Performance Start Year Range2,028 – 2,029
Minimum Competition Policies to Implement1

population

Opportunity for New States to Join2
Total State Participants6

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