The road AHEAD: Maryland to be a test-subject state in new federal hospital model

Lawmakers gathered to celebrate the ribbon-cutting of the UM Capital Region Medical Center in Prince George’s County. Photo by Hannah Gaskill.

Maryland is set to be one of two 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 (CMS) announced Tuesday that Maryland and Vermont 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 (HSCRC), 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.”

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.

“We certainly have a lot of work in front of us,” Kromm said. “Particularly, our primary care investment and our health equity plan. I think a lot of that infrastructure will be, kind of, newly created. So we’re going to have to do a lot of engagement with the communities around the state to do that.

“But I really look at that as an incredible opportunity to advance the state’s goals around health and wellness for all Marylanders,” he said.

Associations representing state hospitals and physicians say they plan to work closely with HSCRC to ensure Marylanders receive quality and affordable health care while the state transitions into the federal program.

“While this is welcome news … this action and award signal a shared responsibility to work together on a statewide health care model that balances patient access, health equity, and hospital financial sustainability with affordability for consumers,” according to a statement from the Maryland Hospital Association.

Gene Ransom, CEO for MedChi, said that the state’s medical society will also work closely with the HSCRC during the pre-implementation period.

“We’re going to push hard to try to make things better for physicians, patients and the public health of Maryland,” Ransom said. “We have a lot of work to do to keep improving this.”

Ransom recognizes that coordinating state and federal programs could be a challenge.

“I think whenever you’re changing the arrangement with the federal government, that there could be more restrictions or reduction in the amount of funds that are available that we have to take into consideration,” Ransom said. “This is a very complicated system here in Maryland, and you have to be careful when you’re making changes to it.”

But he also said that the additional support could help improve access and quality of care down the line.

“This is a big win for the Moore administration because, by getting the planning grant, it allows us to continue the process and have a discussion about how we keep what we have,” Ransom said.

“We’ve (MedChi) been engaged at all levels of this consistently over the last 10 or 15 years. And now, AHEAD is the newest iteration of what the Maryland model is and how it is going to move forward,” he said.

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