Commissioner King shares insight on RI joining CMS AHEAD Model
The Centers for Medicare & Medicaid Services (CMS) has launched the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a bold initiative to curb health care cost growth, improve population health, and reduce disparities in health outcomes. This voluntary, state total cost of care model supports participating states with funding and resources to enhance primary care investment, stabilize hospital finances, and connect beneficiaries to community resources. Rhode Island was recently announced as part of Cohort 3 and will receive up to $12 million in cooperative agreements to implement the model over the next 5-6 years. We recently connected with Health Insurance Commissioner Cory King for more insight into this exciting commitment to health system transformation and equitable care delivery.
1. CMS announced this fall that RI was successfully selected to participate in the AHEAD Model, with some early work starting this month. Tell us more about your goals for participation. What do you hope to achieve throughout the initiative?
My expectation is that participation in AHEAD will help us achieve more affordable and equitable health care for Rhode Island residents. AHEAD offers some very appealing strategies to get us there. Foremost among these strategies is a core focus on primary care across all-payers and new Medicare investments in primary care practices. AHEAD also creates a platform for aligned approaches to health care payment and care management across Medicare, Medicaid, and commercial payers while testing a new payment model for hospitals. AHEAD is a voluntary program, meaning that hospitals and primary care practices must choose to join. This will require collaboration and partnership among all parties, including the State, to move forward. In my experience in Rhode Island, collaboration and partnership have been the key to driving success in the health care space. The work and achievements of CTC-RI is a prime example.
2. What challenges may this work address?
AHEAD is a state total cost of care model intended to produce savings over time for consumers, employers, and taxpayers while improving quality and health equity. AHEAD emphasizes that these savings should not come at the expense of primary care providers. In fact, increased resourcing for primary care is a core component of the model. Our expectation is that these increased resources from Medicare, combined with local payer investments in primary care, will support the expansion and sustainability of the primary care workforce over time. Additionally, our hospitals have faced documented financial challenges. These challenges stem from several factors. AHEAD will test a new hospital global budget payment model that is intended to provide predictable, stable revenue for hospital facility services.
3. What ways may primary care teams notice, or be impacted by, the state's participation in the AHEAD Model?
AHEAD will bring new Medicare dollars to support practices that participate in Primary Care AHEAD. These prospective monthly payments will be paid in addition to Medicare fee-for-service billing, including the new HCPCS codes for advanced primary care management that were introduced in the 2025 Medicare Physician Fee Schedule. Medicare’s goal through AHEAD is to increase the percentage of the Medicare dollar that is dedicated to primary care and to work with the State to achieve a Medicare primary care investment target. The State will recruit practices to join Primary Care AHEAD and create an all-payer primary care investment target. The all-payer target, which is in addition to the Medicare-specific target, will ensure that all practices, including pediatric practices, have a stake in this work. In anticipation of AHEAD, and following OHIC’s December 2023 report on primary care, we have moved to amend regulations governing commercial insurer primary care funding obligations. This move will support our progress in AHEAD.
Through the work of CTC-RI, Rhode Island’s experience with the patient-centered medical home model and integrated behavioral health puts us in an ideal position to take this step. AHEAD is a piece of an overall strategy Rhode Island needs to deploy to support and build the primary care workforce over time.