New York State Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
Introduction to the New York AHEAD Model
New York State has been selected to participate in the Centers for Medicare & Medicaid Services (CMS) States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. The AHEAD Model is a state-based alternative payment and delivery model to transform health care, advance health equity, and improve population health through a 10-year cooperative agreement with CMS.
New York State's AHEAD Model will transform more than $5 billion in health care spending to value-based payment arrangements through global hospital budgets and investments in advanced primary care. The model will support four key objectives:
- Improve financial stability for safety net providers
- Slow total cost of care growth via an all-payer total cost of care target
- Invest in primary care and health care quality
- Advance health equity by connecting patients to health-related social needs (HRSN) services through Social Care Networks
New York State will use accountability targets to contain total cost of care growth and drive measurable improvements in quality, population health, and health equity under the AHEAD Model.
Model Focus
New York State will implement the AHEAD Model in the following five counties in the downstate region: Bronx, Kings, Queens, Richmond, and Westchester. Participation in the model is voluntary, and any hospital located in these counties can participate.
Hospital Global Budget
Through the Hospital Global Budget Initiative, participating hospitals will be paid a pre-determined, fixed annual budget. The global budget will provide stable payments to hospitals, allowing them to focus on population health improvements while controlling cost growth.
New York State will design a Medicaid hospital global budget methodology that serves the unique needs of the Medicaid population. The AHEAD Model will also promote alignment of Medicaid, Medicare, and commercial payers in the State.
Key activities for participating hospitals include:
- Engaging in global budget payment methodology and payment reform
- Developing a health equity plan
- Undertaking quality improvement activities to address community-specific disparities
- Collecting and reporting standardized patient demographic data
- Collaborating across diverse AHEAD stakeholders and partners
Primary Care AHEAD
Primary Care AHEAD will provide participating primary care practices with enhanced Medicare payments to increase their capacity to implement value-based payment models and transform care delivery, including:
- Integrating behavioral health care
- Advancing care management and coordination
- Addressing HRSNs
This initiative builds on the expansive Patient-Centered Medical Home (PCMH) program that is making statewide investments to expand the reach of advanced primary care models. Through the New York State PCMH program, PCMHs can currently receive enhanced payments for Medicaid and Child Health Plus (CHPlus) members.
Primary care practices in the downstate region are eligible to participate in Primary Care AHEAD if they are participating in the New York State PCMH program. In addition, hospital-owned practices can participate if their hospital is participating in the AHEAD Hospital Global Budget initiative.
Additional Resources
- NYS AHEAD Project Narrative - (PDF)
- List of Hospitals that have submitted a Letter of Interest (LOI) for participation in AHEAD - (PDF) - as of 10/31/2024
- CMS AHEAD Model webpage
- CMS Primary Care AHEAD Fact Sheet
- CMS AHEAD Hospital Global Budget Fact Sheet
