The Centers for Medicare & Medicaid Services has announced changes in two of its Medicare accountable care models: the Achieving Healthcare Efficiency Through Accountable Design (AHEAD) Model and the Transforming Episode Accountability (TEAM) Model.
The AHEAD Model is a state total cost of care model that seeks to drive state and regional health care transformation and multi-payer alignment with the goals of improving the total health of the population involved, promoting competition and choice, enhancing prevention, and empowering patients. Under the changes, states must implement at least two policies focused on promoting choice and competition in their health care markets and on prevention, including chronic disease prevention.
AHEAD’s revised framework will offer risk-bearing geographic entities additional tools and enhanced flexibilities to improve health outcomes and reduce spending for their patients while receiving shared payments (or losses) through two-sided risk arrangements.
CMS also is introducing payment reforms for patients with traditional Medicare and establishing new transparency requirements around total cost of care and primary care investment targets. The AHEAD Model also has been extended through 2035.
Learn more about the AHEAD changes ahead from this CMS announcement and more about the program from the AHEAD model web page.
CMS also has shared details about how it will implement the skilled nursing facility Medicare three-day rule waiver under its TEAM model. In a newly posted bulletin, the agency presents detailed information about the criteria it will employ to determine whether it will pay for skilled nursing facility or swing bed care without a three-day inpatient stay. Find that bulletin here. The policy takes effect on January 1.