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GMCB joins Scott and AHS in signing AHEAD Model agreement

Submitted by tim on

Vermont Business Magazine The Green Mountain Care Board (GMCB) voted 3-1, with one Board Member abstaining, to sign the State Agreement with the federal Centers for Medicare & Medicaid Services (CMS) to enter the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.  

The state's current all-payer provider, OneCare, is dissolving at the end of this year. The AHEAD program would not begin until January 1, 2027.

Only one other state, Maryland, currently is participating in the AHEAD model. Regulators said they are concerned over the complexity of the program and both the GMCB and the administration can get out of it if it's not working out. They're also concerned that it might cost more than it's worth. However, the state will be getting $150 million additional Medicare funds a year to implement the program, which also expands Medicare services. The state receives over $3 billion a year in Medicaid and Medicare funding from the federal government.

GMCB joined Governor Phil Scott and the Agency of Human Services (AHS) in signing the AHEAD agreement, provided that certain requirements necessary to properly implement and execute the Model are in place.  GMCB’s vote requires the Board to automatically terminate the agreement if conditions important to successful Model execution do not occur.

Vermont will participate in Cohort 2. The new funding model will take effect January 1, 2027. 

Over the coming year, AHS and its partners will be working to stand up the processes and structures necessary to implement the agreement. Starting in 2026, the State will recruit Vermont hospitals to join the Medicare Fee for Service Hospital Global Budget program. Throughout the transition process, Vermont will continuously assess whether the model meets Vermont’s needs. The State has the option to withdraw from the agreement if cost and quality targets are not met.  

“Vermonters know that the high cost of healthcare is one of the critical affordability challenges we face,” said Secretary of Human Services Jenney Samuelson. “Our healthcare system needs support to evolve to better serve the needs of Vermonters. This agreement will help by moving us toward a funding model that better supports the care Vermonters need.”  

Elements of Vermont’s AHEAD agreement include: 

  • Establishment of a new way of funding Vermont’s healthcare system. This model, known as Total Cost of Care, gives Vermont the authority to more flexibly manage and control healthcare costs and quality and make important investments in our system. 
  • Up to $150 million in additional Medicare funds annually starting in 2027, with increases each year to reflect inflation, to strengthen Vermont's healthcare system and fund services not typically covered by Medicare. 
  • Establishment of a hospital Global Budget model to help keep care affordable and predictable for Vermonters while providing budget predictability and flexibility to allow hospitals to transform and adapt to better serve patients.   

 

“Many people put in a lot of work to make this a reality, and I am grateful for their efforts,” said Brendan Krause, State Director of Healthcare Reform. “This agreement is the culmination of years of work by AHS and many partners, and months of negotiations with the federal government, to create an agreement to help improve access and make care more affordable. In particular, I would like to thank our excellent team here at AHS and the membership and staff of the Green Mountain Care Board.” 

“The Green Mountain Care Board approved Vermont’s participation in the AHEAD Model, subject to specific conditions that safeguard Vermont’s interests and protect the State against potential risks associated with this innovative, and ambitious, policy initiative,” said GMCB Chair Owen Foster.  “The AHEAD Model continues funding for primary care, the Vermont Blueprint for Health, and the Support and Services at Home (SASH) program.  These dollars are critically important to the State, and execution of the State Agreement maintains an option as the State seeks paths out of our affordability, access, and health system sustainability challenges”.

Foster expressed gratitude to Governor Scott and the Governor’s office, and AHS, GMCB, and CMS staff and leadership for their extensive efforts and commitment to exploring the Model.  Chair Foster further recognized the significant involvement and effort made by the Vermont Legislature, numerous healthcare providers, the Vermont Association of Hospitals and Health Systems, and the Health Care Advocate. 

States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

The States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model is a new federal program that would allow Medicare to join Vermont’s health care reform efforts to improve the health of Vermonters, advance health equity so that everyone can reach their full potential for health, and reduce the growth of healthcare costs. Vermont was selected to participate in the AHEAD Model in July 2024. 

The primary components of the model are:

  • Hospital Global Budgets, where hospitals will be paid a fixed amount of revenue, or a “global budget,” to provide services to Medicare fee-for-service beneficiaries.
  • Primary Care AHEAD, which is a voluntary program for primary care practices to receive an additional payment from Medicare to provide coordinated care to Vermonters with Medicare coverage.

 

Learn more about the AHEAD Model: 

 

The Green Mountain Care Board (GMCB) is a 5-member, independent Board with a vision of a sustainable and equitable healthcare system that promotes better health outcomes for Vermonters. The GMCB was created in 2011 with an ambitious mission to drive system-wide improvements in access, affordability, and quality of healthcare to improve the health of Vermonters. Through public meetings, the GMCB ensures a transparent approach to healthcare regulation and a voice for stakeholders, including healthcare organizations, clinicians, and members of the public. With a holistic, data driven approach, the GMCB carries out its regulatory duties, supports innovation in healthcare delivery and payment reform, and serves as an important resource for independent, transparent analyses of Vermont’s healthcare system performance.

Source: 1.21.2025. Montpelier, VT – The Green Mountain Care Board (GMCB)

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