Maryland Officials Outline AHEAD All‑Payer Model, Highlight Tools to Address ER Wait Times and Hospital Stability

Laura Herr Scott, Maryland’s secretary of health, and John Krom, executive director of the Health Services Cost Review Commission, presented an overview of the AHEAD (Advancing All‑payer Health Equity Approaches and Development) model and outlined how the state is preparing to implement its commitments while managing risks from federal changes.

“The AHEAD model preserves important characteristics of our hospital rate‑setting system and enables a statewide health equity strategy,” Krom said, adding that “Maryland receives an additional $1,700,000,000 in federal payments for Medicare and Medicaid patients,” a funding stream tied to having the state’s waiver arrangement in place.

Scott and Krom framed AHEAD as a successor/extension of Maryland’s long‑standing all‑payer hospital rate setting and the 2019 total cost of care agreement with the federal government. They said the state signed a high‑level state agreement with the federal Innovation Center (CMMI) in November to preserve core elements — rate‑setting authority, the uncompensated care mechanism and a trajectory of Medicare savings that the state deems reasonable and achievable. Krom said that enumerating termination triggers in the state agreement (the primary trigger being failure to meet Medicare savings targets) helped “de‑risk” the model in the event of federal administrative changes.

Officials said AHEAD expands the scope of the model to align all payers around primary care, include Medicaid in advanced payment approaches, and explicitly advance health equity and behavioral health integration. Scott said the model also supports funding for population health investments and primary care start‑up funding, and that the state had released nearly $20,000,000 in start‑up funding for new primary care access sites in underserved areas.

Committee members pressed officials on practical capacity issues. Delegates raised longstanding concerns about long emergency department wait times, hospital bed shortages, and how the AHEAD model helps hospitals expand capacity. Krom said the state will use multiple levers: assessing geographic mismatches between capacity and population, encouraging hospitals to shorten inpatient length of stay where it is high, using certificate‑of‑need and rate adjustments to fund capital investments when appropriate, and ensuring hospital rates scale with population growth and market share.

On the uncompensated care mechanism — the system that pools and redistributes hospital uncompensated care payments — Krom explained hospitals’ rates are adjusted to create a pooled fund; hospitals report bad debt and uncompensated care and payments are reconciled over time. He and Scott said Maryland’s uninsured rate is among the lowest in the nation, aided by Medicaid expansion and state policy, which reduces uncompensated care pressure compared with many states. Krom cautioned that a significant rise in the uninsured population would increase uncompensated care demands.

Scott and Krom emphasized behavioral health and community services as part of the strategy to reduce emergency department demand: expanding primary care access, mobile crisis teams, crisis centers, inpatient substance use disorder capacity for adolescents, and programs under Medicaid authorities such as 1915(i) for families with children with severe emotional disturbance.

Ending

Officials said key near‑term milestones include setting statewide targets for population health, health equity and quality measures under the AHEAD model; they urged continued stakeholder engagement as the state moves from a high‑level agreement toward detailed implementation rules.