AHEAD: Achieving Healthcare Efficiency Through Accountable Design
“AHEAD (renamed the Achieving Healthcare Efficiency through Accountable Design) is a voluntary state total cost of care (TCOC) model that aims to drive state and sub-state-regional health care transformation and multi-payer alignment to improve the total health of a state’s population while lowering costs. AHEAD includes 6 state participants (Cohort 1: Maryland, Cohort 2: Connecticut, Hawaii, and Vermont, and Cohort 3: Rhode Island and New York) and will run through December 31, 2035, for all cohorts.”
Source: US Centers for Medicare and Medicaid Services, AHEAD (Achieving Healthcare Efficiency through Accountable Design) Model, Accessed July 4, 2026.
“The AHEAD Model consists of four primary components to assist states in meeting their Total Cost of Care (TCOC) and quality targets:
“• Cooperative Agreement Funding: CMS will provide cooperative agreement funding for states to invest in planning activities that support model goals during the pre-implementation period and initial performance years. This period will be critical to the model’s success and will require significant effort from the state and its partners, particularly in implementing the Medicaid methodologies to align with the key Medicare components of the model.
“• Primary Care AHEAD (PC AHEAD): Primary care practices located in a participating state or sub-state region will have the option to participate in PC AHEAD, to advance ongoing local Medicaid transformation efforts and increase Medicare investment in primary care. Participating practices receive prospective, risk-adjusted Enhanced Primary Care Payment based on the medical and social complexity of their patient populations, along with quality-based adjustments, and can choose from four payment pathways, including two offering prospective payments in lieu of part or all of corresponding Medicare Fee-for-Service payments. This structure supports the delivery of person-centered, coordinated care and encourages continuous improvement in population health.
“• Hospital Global Budgets (HGBs): Global budgets provide hospitals with a predictable amount of revenue for the upcoming year for a specific patient population or program, such as Medicare fee-for-service beneficiaries. A global budget encourages hospitals to eliminate avoidable hospitalizations and improve care coordination between hospitals, primary care providers, and specialists.
“• Geo AHEAD: Geo AHEAD uses competitive bidding to select multiple Geo Entities within each participating state or sub-state region, ensuring beneficiary choice and promoting market competition. Geo Entities are accountable for total cost of care (TCOC) and quality outcomes for attributed beneficiaries, who may be aligned through voluntary selection, claims-based attribution, or geographic assignment.”
Source: US Centers for Medicare and Medicaid Services, AHEAD (Achieving Healthcare Efficiency through Accountable Design) Model, Accessed July 4, 2026.
Maryland Health Services Cost Review Commission: The AHEAD Model
Maryland: All-Payer Model
• The AHEAD (Achieving Healthcare Efficiency through Accountable Design) Model
Oregon: Universal Health Plan
Washington: WA Cares Fund
Health System Overview
Health System Rankings
Health System Outcomes
Health Expenditures
Health System Financing
Coverage and Access
Costs for Consumers
Health System Resources and Utilization
Preventive Healthcare
World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.
Page last updated July 4, 2026 by Doug McVay, Editor.