ARTICLE: Considerations for Academic Medical Centers Moving AHEAD
AUTHORS: Anjali Bhatla, Scott A Berkowitz
JOURNAL: JAMA Health Forum. 2024 Nov 1;5(11):e243781. doi: 10.1001/jamahealthforum.2024.3781.
In 2023, the Centers for Medicare & Medicaid Services announced a voluntary, state-based total cost of care model, States Advancing All-Payer Health Equity Approaches and Development (AHEAD). The AHEAD model aims to curb growth in health care costs through hospital global budgets, in which hospitals receive fixed payments based on historical revenue and services provided, and annual budget increases are capped at the inflation rate to dissociate hospital revenue from volume. The model also strives to increase primary care investment and focus on health equity through state-based health equity plans. The model requires multipayer alignment between traditional Medicare, Medicaid, and at least 1 commercial payer.
The AHEAD model builds on the Maryland Total Cost of Care (TCOC) model, which comprises all-payer hospital budgets set by the Health Services Cost Review Commission (HSCRC) state regulatory body and the Maryland Primary Care Program. Evaluation of the Maryland model showed reductions in spending that yielded approximately $689 million in net savings to Medicare between 2019 and 2021.1 Maryland, Vermont, and Connecticut will be the first cohort of states to participate in the AHEAD model. Although we recognize the need to reduce national growth in health care costs, academic medical centers (AMCs) may require unique participation considerations. Herein, we reflect on the Johns Hopkins Medicine experience participating in statewide hospital global budgets in Maryland and considerations for AMC participation in other states.
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