The Center for Medicare and Medicaid Innovation (CMMI), part of the Department of Health and Human Services (HHS) that is managed by the Centers for Medicare and Medicaid Services (CMS), announced on September 2 policy and operational changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model that will take effect in January 2026.

The AHEAD Model is a multi-payer, total cost of care model being tested in​ Maryland, Connecticut, Hawaii, and Vermont through CMMI. Under the announced changes, the model has now been extended one more year running through December 31, 2035.

One first-ever change is that CMS will begin attributing all traditional Medicare fee-for-service (FFS) beneficiaries, who are not already associated with an accountable care organization in these markets, to a risk-bearing Geographic Entity (GE) in the participating states.  This change will make these GEs accountable for the total cost of care for these Medicare FFS beneficiaries but offer them “additional tools and enhanced flexibilities to improve health outcomes and lower spending.”

Successful GEs will be eligible for shared savings, as well as losses. In turn, the attributed beneficiaries will be eligible for incentives offered by these GEs but retain their traditional Medicare protections.

More details on the AHEAD program can be found here and the announcement of the changes to the model is here.