Frequently asked questions about Connecticut AHEAD
Who is responsible for Connecticut AHEAD?
The Connecticut Office of Health Strategy (OHS) serves as the lead agency for Connecticut AHEAD. The Connecticut Department of Social Services has partnered with OHS to bring this model to Connecticut and will manage all Medicaid related aspects of the program. The Connecticut Office of the State Comptroller will participate as a healthcare payer representing the Connecticut State Employee health insurance plan.
What does total cost of care mean?
States that participate in Total Cost of Care (TCOC) models have agreed to be accountable for quality and population health outcomes, and to take steps to control healthcare cost growth. TCOC models include all healthcare payers, including Medicare, Medicaid and private insurers and plans. Connecticut’s Healthcare Benchmarks Initiative, which sets statewide cost growth and quality benchmarks, as well as primary care spending targets, sets our state ahead of others in these efforts.
When will Connecticut AHEAD begin?
Connecticut AHEAD began planning activities upon receiving the federal award in July 2024. The model requires extensive planning and development of complex financial models, engagement of key stakeholders including hospitals, physician practices and healthcare payers, as well as development of Statewide Health Equity Plan by the Connecticut Head Advisory Committee. Implementation of Connecticut AHEAD is scheduled to begin in January of 2027.
Are hospitals and doctors required to participate in Hospital Global Budgets or Primary Care AHEAD?
Participation in both Hospital Global Budgets and Primary Care AHEAD is voluntary. OHS and DSS will work with hospitals, and physician practices, including federally qualified health centers, to help them understand if Connecticut AHEAD is a good fit for their organization.
How is Connecticut AHEAD funded?
Connecticut AHEAD is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $12 million with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.
Global Budgets
What are the key advantages of a global budget for hospitals?
Global budgets provide a predictable source of revenue and gives hospitals the flexibility to customize services for their patients and communities. In Pennsylvania, for example, financially struggling rural hospitals were able to keep their doors open through the COVID19 pandemic by knowing their annual budgets upfront. Beyond the pandemic, global budgets were key for rural hospitals providing stable funding to address the challenges of adapting to changes in population size and needs. In Maryland, a recent third-party evaluation of global budgets showed reductions in unnecessary hospital utilization and better follow-up. A hospital launched a nurse-led program to bring primary care directly to the community to avoid unnecessary emergency department visits.
Are AHEAD global budgets a block grant?
No. Block grants typically refer to grants made by the government for various purposes. The purchasing power of block grants often diminishes over time if they are insufficiently adjusted for inflation and other factors as part of the budgeting process. In contrast, the AHEAD global budget is an agreement between a payer (like Medicaid) and an individual hospital. Unlike a block grant, the AHEAD global budget adjusts on an annual basis to ensure it is keeping up with costs and meeting the specific needs of the hospital and the population it serves. For example, if the hospital sees sicker patients there would be an upward adjustment of the global budget. It also accounts for inflation and shifts in patient volume.Are AHEAD global budgets a form of capitation?
Unlike capitation, where payments are fixed per patient, AHEAD provides the state with the flexibility to adjust the budget annually, decide which service lines to include, and adapt to community needs. If hospitals reduce or discontinue certain services, they will still retain the annual budget allocated, ensuring financial stability.
What happens if a hospital runs out of money?
The hospital does not get all the money upfront. The global budget payment system makes payments on a bi-weekly basis, stabilizing cash flow from all participant payers. The hospital needs to manage their budget wisely akin to most other businesses.Monitoring for Quality and Patient Care Impact
How will the state monitor for unintended consequences?
The AHEAD model aims to enhance the quality of care and access to hospital and acute services for Connecticut patients. Both CMS and the state will closely monitor the model to identify and address any unintended consequences, including, but not limited to, changes in the delivery of essential services, deterioration in population health outcomes, and performance on access, quality, and equity measures. The state will also monitor issues such as care stinting and restricted beneficiary choice.
Could global budgets lead to gaps in care?
This is a legitimate concern. We will be creating a comprehensive plan to monitor and safeguard against any potential gaps. This will be a priority during the planning phase and will be done in partnership with key stakeholders. We will base our approach on prior efforts in Connecticut and on existing frameworks developed by CMS and other states.
Do patients get better care under the current fee-for-service system?
In a fee-for-service system, often patients are getting unnecessary care or very high cost care where lower cost care would be just as good. In order to stay afloat, hospitals need to focus on high-profit services, which are often not in line with what the community needs (e.g. behavioral health services). Further, there is little incentive to coordinate various aspects of care and see the patient as a whole.
Further, there is little incentive to coordinate various aspects of care and see the patient as a whole since a fee-for-service system generally doesn’t pay for “non-billable” services. Things like care coordination, community health workers, nutrition, pharmacy education, and many other ancillary primary care services can be better supported in this type of global payment system.
Model participation and program details
What other payers are participating? Will Medicaid be alone?
Under the terms of the AHEAD model Medicare fee-for-service and at least one other commercial plan are required to participate. Medicaid cannot be the sole payer.
What other states are participating?
The AHEAD model is a demonstration initiative developed by the CMS Innovation Center, drawing on insights gained from the adoption of global budgets in Maryland, Pennsylvania, and Vermont. The model is set to run for a total of 11 years. Connecticut is one of six states selected to participate, alongside Maryland, Vermont, Hawaii, Rhode Island, and a sub-region of New York.
What’s the timeline for this to get off the ground?
As part of Cohort 2, Connecticut’s pre-implementation period will span from July 2024 to December 2026, with the model officially launching in 2027. The state opted for an extended pre-implementation phase to allow more time for thorough planning, design, and robust stakeholder engagement. While provider participation in the model is voluntary, Connecticut is required to have at least 10% of Medicare fee-for-service revenue under a global budget by 2027 and 30% by 2030 with at least one commercial payer participating by 2028.
How much funding is available?
The AHEAD model allocates $12 million in federal funding over the initial 5.5 years (2024-2029) of the 11-year demonstration period. These funds will support planning, pre-implementation activities, and model monitoring and oversight for participating hospitals and primary care providers. The Office of Health Strategy has received $2.4 million for the first planning year, which will be used to hire a dedicated team, engage vendors to assist with payment design, develop an advanced primary care strategy, and establish monitoring processes to assess the model's impact. It is important to note, this federal funding does not directly fund healthcare services or reimburse providers for such services.What is the AHEAD Advisory Committee and what will it do?
An AHEAD Advisory Committee has been established under the leadership of the Governor’s Health Care Cabinet. This 21-member committee includes a diverse group of healthcare providers (both primary care and hospital clinicians), hospital representatives, community-based organizations, health equity advocates, consumers, payers, and community leaders. The committee will offer recommendations and provide guidance to OHS and DSS on critical implementation activities for the program, including the selection of quality and equity measures to support ongoing program monitoring.Primary Care
Is Primary Care part of AHEAD?
Yes. The Connecticut AHEAD model presents a unique opportunity to boost primary care investment in a controlled, measurable environment. Under AHEAD’s Enhanced Primary Care Payment (EPCP), participating providers can receive between $17 and $21 per member per month for Medicare Fee-For-Service beneficiaries. For example, a provider with 500 patients could receive between $8,500 and $10,500 monthly ($102,000 to $126,000 annually), which can be used to hire care coordinators, behavioral health professionals, or fund other primary care transformation efforts. This enhanced payment is prospective, so that providers can plan and depend on the revenue and plan accordingly.Why is Primary Care Important?
Investments in primary care have been shown to reduce hospitalizations, improve care quality, enhance patient experience, and decrease emergency room visits. States like Oregon have experienced significant savings from such investments—each $1 spent on the Patient-Centered Primary Care Home program resulted in $13 in savings across other services. Despite these benefits, Connecticut’s investment in primary care remains low and is growing slowly. In 2022, the state allocated only about 4.9% of total medical spending to primary care, far below the 10% target set for 2025. Projections from Connecticut’s Healthcare Benchmark Initiative suggest that the primary care spending in 2023 has decreased further to approximately 4.5%. Without a substantial increase in funding, the state risks falling short of meeting its residents' health needs, while also struggling to recruit and retain primary care practitioners
To submit your questions about the Connecticut AHEAD Advisory Committee, Statewide Health Equity Plan, Hospital Global Budgets, Primary Care AHEAD or other aspects of the model please contact us at OHS-AHEAD@ct.gov