New Family Medicine Model is Thinking One Step AHEAD

* Thank you to Dr. Amar Duggirala, President-Elect for contributing to this piece.

There’s some important things happening in Maryland we want to make sure you’re aware of – Our state was selected to implement the new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model and MDAFP is doing advocacy work around this with you in mind. With this new model, Maryland will build upon the successes of the Total Cost of Care (TCOC) model and build on state-wide efforts to improve quality, health equity, and access to care, as well as to control healthcare costs. The key goals of primary care under this model is to:

• Increase investment in primary care as a proportion of TCOC for Medicare Fee-for-Service and across all-payers.
• Align Medicare’s primary care strategy with efforts already underway in state Medicaid programs, including enhanced care management, behavioral health integration, and referrals for health-related social needs.
• Target populations most in need of improved access to high-quality primary care by ensuring that FQHCs and RHCs can receive enhanced primary care payments and adjusting payments for medical and social risk given the particular needs of the patients they serve.
• Encourage more providers to build increased capacity to deliver advanced primary care.

Our work for this program is being done to advocate for improved healthcare for all Marylanders. Whiles many of the details of this new program are still being worked out between CMS and the state, we are encouraging the state to support and prioritize the Maryland Primary Care Program (MDPCP) – to keep an on-ramp track so new practice sites can be added expand MDPCP, to include Medicaid and private payers, incorporate transformation and MDPCP gap services, and more. All eyes are on us as we’re only 1 of 2 states selected to implement this new program.

This past week (November 1) the AHEAD model became official and was signed by Maryland Governor Wes Moore and CMS Administrator Chiquita Brooks-LaSure. Dr. Duggirala had the privilege to attend. This model will be in pre-implementation phase until 12/31/2025 and will start as of 1/1/2026 with nine performance years until 12/31/2034. There will be a transition period after 2034 for possible permanent options.

The AHEAD model will include primary care investment targets both for Fee-For-Service Medicare, Medicaid, and private payers. MDAFP believes this will be a net positive for family physicians as it will increase investment in primary care. The model will also have statewide quality, equity, and population health targets.

Primary care practices will be required to accept Medicaid beneficiaries, and be part of the new Medicaid Advanced Primary Care Program starting in 2027, in order to participate in the AHEAD model. Practices in the AHEAD model will receive value based payments, similar to ones they receive in MDPCP, however the exact payment amounts and methodologies are not yet determined.

Primary Care practices will have the opportunity to join the program sometime in 2025 and start the program in January 2026. The program will run parallel to the MDPCP program at least until 2028. Practices may be able to decide if they want to stay in MDPCP or move to AHEAD for years 2026-2028.

MDAFP has given significant feedback to the state of Maryland while they were negotiating this agreement with CMS to make this model less onerous to physicians and primary care practices. MDAFP will continue to advocate for family physicians over the next year while the details of the model are being determined. We’ll continue to keep you informed on the progress of this new model and encourage you to give us your thoughts as those opportunities arise.

For information about the state’s efforts, visit Maryland’s Health Services Cost Review Commission webpage.

Kind regards,

Becky Wimmer

Your Executive Director