Vermont one of two states chosen to test federal program to improve patient outcomes

By Danielle Gaines
©2024 Maryland Matters

Vermont and Maryland have been chosen as test-subject states for a new federal program that officials hope will improve patient outcomes and bridge inequities while constraining hospital and medical costs.

The U.S. Centers for Medicare and Medicaid Services announced Tuesday that Vermont and Maryland will be the first states to implement the new States Advancing All-Payer Health Equity Approaches and Development Model, called the AHEAD Model.

The federal AHEAD model aims to help participating states implement what’s called a total cost of care model, in which states take responsibility and accountability for health outcomes of their patients.

Maryland is ahead of the game: It already has a total cost of care model. In fact, the federal program takes a cue from hospital-rate setting programs in Maryland and states like Vermont and Pennsylvania.

The Maryland’s total cost of care model requires the state to annually meet certain metrics that indicate the state has reduced per capita hospital expenditures while ensuring that Marylanders receive quality health care services. The state’s model sets a “global budget” for hospitals across the state, which is the total amount of revenue each hospital can earn in a year.

It is regulated by the state’s Health Services Cost Review Commission, which was involved in Maryland’s AHEAD application process and will help run the program.

“It certainly builds off of what we have in place for the total cost of care model,” said Jon Kromm, HSCRC’s executive director. “I think the main thing that the AHEAD model allows us to do is essentially expand and put more focus on our support for primary care in Maryland and … population health and health equity.”

Maryland Gov. Wes Moore (D) said Tuesday that the federal grant comes with $4 million in funding to support Maryland’s implementation of the program.

“Maryland is ready to lead on health care. Today, we deepen our commitment to affordability and accessibility — and we hope other states will follow our example,” said Moore said in a prepared statement.

Kromm added that the $4 million will be used for grants to address population health and provide some technology infrastructure to coordinate health efforts across the state.

“All of that is largely to build the infrastructure that we need in order to execute the population health and health equity strategy once we get to the implementation phase of the AHEAD model,” Kromm said.

Vermont and Maryland will have an 18-month pre-implementation period, when they will negotiate with CMS to determine how the AHEAD model will function for each state. The goal is to have it functioning in both states by 2026 and operating for at least nine years.

Connecticut was also tapped in Tuesday’s announcement, but it is not scheduled to get its program off the ground until 2027. Other states still have time to apply for later rounds of the program.

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