The Centers for Medicare & Medicaid Services (CMS) recently announced the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a groundbreaking initiative aimed at curbing healthcare cost growth, improving population health, and advancing health equity. As a leading value-based care consultancy, Benevolence Health is uniquely positioned to guide hospitals and health systems through this transformative journey.
Here are the top 5 considerations for health systems under the AHEAD model and how Benevolence Health can support your organization:
Hospital Global Budgets: Health systems will need to carefully evaluate whether to participate in the model's hospital global budget program. This involves transitioning from fee-for-service to a fixed annual budget for inpatient and outpatient facility services. Systems should assess the potential financial impacts, opportunities for efficiency gains, and ability to manage population health under a global budget.
Primary Care Transformation: The model emphasizes strengthening primary care through the Primary Care AHEAD program. Health systems should consider how to support their affiliated primary care practices in meeting care transformation requirements around behavioral health integration, care coordination, and addressing health-related social needs. There may be opportunities to better coordinate between hospitals and primary care.
Total Cost of Care Accountability: Health systems will be part of statewide efforts to control the growth of the total cost of care across Medicare, Medicaid, and commercial payers. This creates incentives to reduce unnecessary utilization and coordinate care across the continuum. Systems should evaluate their capabilities around population health management.
Health Equity Focus: The model requires participating hospitals to create health equity plans and adjust global budgets based on equity performance measures. Health systems will need strategies to reduce disparities, collect demographic data, and connect patients to community resources.
Alignment with State Priorities: Since states play a key role in implementing AHEAD, health systems should engage early with state agencies on topics like Medicaid alignment, quality measure selection, and recruitment of hospitals/practices. Understanding and shaping state-specific model designs will be important.
At Benevolence Health, we partner with you. Our comprehensive approach includes executive leader and board support, staff training programs, methodology considerations, and technology infrastructure assessments to ensure your entire organization is prepared for the AHEAD model.
As the landscape evolves, Benevolence Health remains committed to empowering hospitals and health systems with the knowledge, tools, and strategies needed to succeed in value-based care models like AHEAD. Together, we can transform healthcare delivery, improve patient outcomes, and create a more equitable and sustainable health system.
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