The Centers for Medicare & Medicaid Services (CMS) unveiled a new state-focused demonstration model Tuesday. One of the model’s primary objectives is to shift health care spending and utilization more toward primary and community-based care.
The States Advancing All-Payer Health Equity Approaches and Development Model (AHEAD Model) will aim to better address chronic disease, behavioral health and other medical conditions, according to CMS. The agency hopes that participating states will be better “equipped” to promote health equity, greater primary care utilization and more sustainable health care spending.
“In our current health care system, fragmented care contributes to persistent, widening health disparities in underserved populations,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The AHEAD Model is a critical step towards addressing disparities in both health care and health equity while improving overall population health.”
The AHEAD Model is the next iteration of the CMS Innovation Center’s multi-payer total cost of care models.
Another one of the model’s goals is to ensure a state’s providers are delivering “efficient, high-quality and coordinated care” to patients.
“Primary care is the foundation of a high-performing health system and essential to improving health outcomes for patients and lowering health care costs,” Deputy CMS Administrator and Innovation Center Director Liz Fowler said in a statement. “For that reason, the CMS Innovation Center has invested significant time and resources over the years testing models to strengthen primary care and improve care coordination and linkages to organizations that address health-related social needs. Through AHEAD, more states will have the exciting opportunity to both improve the overall health of their population, support primary care, and transform health care in their communities.”
CMS – in tandem with the Innovation Center – also recently unveiled the Guiding an Improved Dementia Experience (GUIDE) Model, which will likely open up opportunity for home-based care providers over the next eight years.
The AHEAD Model could do the same.
“The focus of the AHEAD model is for states to lead in curbing health cost growth, improving population health, and advancing health equity,” Tyler Overstreet Cromer, head of ATI Advisory’s Medicare Innovation Practice, told Home Health Care News in an email. “While hospitals and primary care practices will be key loci of the intervention, the AHEAD model’s focus on advancing health equity and community health and lowering hospitalizations could create opportunities for home health and home care companies, especially if keeping people safe at home and out of the hospital and reaching traditionally underserved groups of people is demonstrated.”
The Washington, D.C.-based ATI Advisory is a health care research and advisory firm.
“This model has a long time horizon to implementation, so forward-thinking home care providers should seek to be at the table for the pre-implementation discussions if your state is applying and should bring ideas for innovative home-based care models that deliver on AHEAD’s goals for improving population health, lowering costs and reducing disparities,” Cromer continued.
The model will include quality measures across three main components: statewide measures, primary care measures and hospital quality programs.
For statewide measures, states will select a set of quality and population health measures from a menu created by CMS. Primary care measures will fall into four domains: addressing behavioral health, prevention and wellness, chronic conditions and acute care utilization.
Participating hospitals will have the ability to receive upward adjustments and bonuses within the hospital quality programs based on overall performance and performance on “disparities-sensitive measures.”
Ultimately, CMS believes a stronger focus on primary care within Medicare will save money and improve access to care.
It is worth noting, however, that the U.S. is facing a significant primary care physician shortage. By the year 2033, that shortage is expected to range from 21,000 to 55,000, according to a study conducted by the Association of American Medical Colleges.
If primary care is leveraged in participating states, however, it’s likely that connecting practices to community-based resources will mean leveraging more home- and community-based care, whether through home health care, personal care, or alternative models such as hospital at home and SNF at home.
CMS outlined four ways it plans to support participating states on their AHEAD Model journeys:
– “Focus resources and investment on primary care services, giving primary care practices the ability to improve care management and better address chronic disease, behavioral health and other conditions.”
– “Provide hospitals with a prospective payment stream via hospital global budgets, while including incentives to improve beneficiaries’ population health and equity outcomes.”
– “Address health care disparities through stronger coordination across health care providers, payers, and community organizations in participating states or regions.”
– “Address the needs of individuals with Medicare and/or Medicaid by increased screening and referrals to community resources like housing and transportation.”
Social determinants of health (SDoH) – or social drivers of health, as CMS put it – have been a growing part of home-based care providers’ strategies over the last couple of years.
Some providers address those social drivers within the home themselves, and some outsource to help meet the needs of patients and families. Most providers tend to do both, utilizing caregivers and partnerships to help address activities of daily living issues.
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