States advancing all-payer health equity approaches and development (ahead) model - new york state's (NYS) office of health insurance programs (ohip) within the NYS department of health outlines its…

States advancing all-payer health equity approaches and development (ahead) model - new york state's (NYS) office of health insurance programs (ohip) within the NYS department of health outlines its vision to implement the center for medicare & medicaid services' (CMS) states advancing all-payer health equity approaches and development (ahead) model. By participating in ahead, NYS will build upon its previous health care delivery system reform efforts and solidify its role as a leader in value-based care innovation to improve population health. From 2014-2020, the state's delivery system reform incentive (dsrip) program converted 80% of medicaid managed care payments into alternative payment arrangements through system-wide payment transformation. In 2018, the state established the nation's largest pcmh model, the NYS patient centered medical home (pcmh) program, to create a patient-centric primary care model. Through these programs, NYS has built a strong foundation of delivery system transformation and cross-sector collaboration required to implement ahead. NYS will use a multi-stakeholder strategy to achieve four key goals that align with core ahead model objectives: (1) improve financial sustainability for safety net providers, (2) reduce total cost of care (tcoc) spend through a value-based payment model, (3) increase investment in primary care and health care quality, and (4) advance health equity. To achieve these goals, NYS will engage and gather input from community stakeholders throughout ahead planning and implementation. The state aims to address safety net hospitals' financial vulnerability and reduce tcoc through medicaid and medicare hospital global budget model payment mechanisms. NYS will also engage commercial payers to participate in ahead to reduce commercial tcoc. To increase investment in advanced primary care, the state will recruit NYS pcmh practices and enable enhanced primary care payments. NYS plans to align ahead health equity initiatives with existing 1115 waiver amendment new york health equity reform initiatives to address hrsn and provide comprehensive population health management for all. NYS intends to implement the ahead model in a sub-state region that includes five downstate counties: bronx, kings, queens, richmond, and westchester, where more than half (55%) of the state's medicaid beneficiaries reside. The state is considering inclusion of additional downstate counties, including manhattan and long island, depending on provider and payor recruitment during pre-implementation planning. To date, NYS has received letters of intent from 13 safety net hospitals (12 of which have deteriorating operating margins) to participate in ahead. These safety net providers treat diverse, medicaid or uninsured patients with high prevalence of health risk factors, including diabetes, food insecurity, unemployment, and hrsn. By supporting these hospitals, the state aims to address these key health disparities across racial, ethnic, and income groups and amplify the impact of current 1115 waiver amendment investments in the state. The state will invest $12 million in ahead funding (from 2025-2030) to enhance NYS' existing health data infrastructure. With this funding, the state will measure and track performance on statewide quality measures, tcoc growth, and primary care investment for ahead. NYS will utilize additional funds to hire subject-matter experts to support health data infrastructure transformation and alignment to NYS' existing health information technology roadmap.