CMS Launching Population Health-focused Payment Model for States, Hospitals

From Becker’s Healthcare

CMS is launching a new population health-focused payment model aimed at addressing chronic disease, behavioral health and overall improvement of care management for states’ populations.

The agency said in a September 5 news release that it would award as many as eight states up to $12 million each to implement the States Advancing All-Payer Health Equity Approaches and Development Model, which is the next iteration of the CMS Innovation Center’s multipayer total cost of care models.

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.

Payments would be for Medicare and Medicaid, and other insurers could also pay participating hospitals for enrolled populations or specific patient groups.

Interested states can apply during two application periods and can participate in one of three groups with staggered start dates and performance years. Specific funding and application information will be released in late fall. States will have 90 calendar days to apply during the first application period. The second application period is expected to open in the spring with a 60-day application period.

Pre-implementation for the first cohort is scheduled for summer 2024. The performance period is scheduled for January 2026 or January 2027, depending on the cohort, and the model will conclude for all participants in December 2034.

More information is available here.