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July 3, 2024

CT among 3 states chosen to participate in federal model to slow healthcare cost growth; hospitals raise some concerns

Contributed Connecticut is one of three states participating in the AHEAD Model.

The U.S. Centers for Medicare & Medicaid Services (CMS) announced Tuesday that Connecticut is one of three states chosen to participate in a new, voluntary “total cost care model” that seeks to curb the growth of healthcare costs.

The States Advancing All-Payer Health Equity Approaches and Development Model, or AHEAD Model, also seeks to improve population health and advance health equity. The project will be guided by the state Health Care Cabinet.

In addition to Connecticut, Maryland and Vermont were also selected to participate in the project. CMS said Hawaii will also participate, pending “satisfaction of certain requirements.”

For participating in the program, Connecticut will receive $12 million over five years to develop and implement the model. Initial funding will support participant recruitment, Medicaid payment model development, a state health equity plan, data alignment and analysis, and additional quality and cost-growth benchmark initiatives, the state said. 

CMS said it selected Connecticut to participate based on a joint application submitted by the state Office of Health Strategy (OHS) and the state Department of Social Services (DSS). 

Gov. Ned Lamont said the award reflects the state’s efforts to improve health care. 

“We will now have additional capacity to advance efforts designed to improve outcomes and control costs,” he said, adding that those efforts include investing more in primary care, strengthening the links with community programs to address health-related social needs and exploring opportunities to transform payment models.

The Connecticut Hospital Association (CHA) issued a statement in support of the state participating in the AHEAD Model, saying the state’s hospitals are aligned with its goals. However, CHA also said it has some concerns.

“Questions remain as to how the model can achieve these goals if it bases budgets on Medicare and Medicaid payment rates that are nowhere near covering the cost of care — a problem that has contributed to many of the issues this model seeks to correct,” the CHA said in its statement.

“Additionally, the model design rewards the government, rather than the communities and local hospitals providing services and care, if long-term prevention outcomes are achieved and community health and well-being improves over time,” the CHA statement said. “We will continue working with the Office of Health Strategy on the details of this program, which both CMS and the state have clearly described as voluntary, including ensuring the model does not build off of Medicaid underpayments.”

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