The CMS AHEAD (All-payer Health Equity Approaches and Development) model represents the most significant shift in hospital payment methodology in a decade. Instead of paying hospitals per service rendered, AHEAD establishes global budgets tied to total cost of care for a defined population. For hospital leadership, this isn't just a reimbursement change — it fundamentally alters what data you need, how fast you need it, and what decisions it must support. Learn more about our AHEAD readiness services.
What AHEAD Changes About Data Requirements
Under fee-for-service, hospitals need to track what was done and bill for it. The data requirements are transactional: procedure codes, diagnosis codes, charge capture, claims submission. Under AHEAD, the data requirements shift dramatically. Hospitals need to track what's working, what it costs across the full care episode — including post-discharge — and whether the population they're responsible for is getting healthier.
This requires capabilities that most hospitals have in pieces but few have integrated:
- ✓Cost-per-episode analytics — not just charges, but actual cost including post-acute care, readmissions, and follow-up services. Fee-for-service accounting tracks revenue. Global budget management requires tracking total cost.
- ✓Population health dashboards — risk stratification, chronic disease management tracking, and readmission prediction. Under AHEAD, the hospital is responsible for health outcomes, not just service delivery.
- ✓Attribution modeling — understanding which patients are "yours" under the global budget. Patient attribution is more complex than billing relationships, and getting it wrong means managing costs you can't see or managing a budget that doesn't reflect your actual patient population.
- ✓Quality measure tracking tied to reimbursement — AHEAD links payment directly to specific quality outcomes. Quality reporting can't be a separate compliance exercise — it needs to be integrated into operational dashboards that leaders review regularly.
Most hospitals have some of these capabilities. Few have all of them integrated into a single operational picture that supports the kind of real-time decision-making global budgets demand.
The Data Readiness Gap
We've assessed dozens of hospitals for value-based care readiness. The most common gaps aren't in clinical data — EHRs generally capture what's needed for clinical purposes. The gaps are in operational data infrastructure.
Cost accounting systems that can't produce episode-level costs. Analytics platforms that report historical volumes but can't model forward-looking population trends. Quality dashboards that are disconnected from financial data, making it impossible to see the relationship between care quality and cost performance. Reporting timelines that deliver monthly data when weekly or daily visibility is needed to manage a fixed budget.
AHEAD requires these data streams to converge. A hospital can't manage a global budget if its cost data, quality data, and population data live in separate systems with separate reporting timelines and separate definitions of basic terms like "episode" and "attribution."
A 60-Day Readiness Assessment
Rather than launching a multi-year transformation project, we recommend starting with a focused 60-day assessment. In that timeframe, you can:
- ✓Inventory your current data assets — what systems hold what data, what quality issues exist, and where the gaps are relative to AHEAD requirements.
- ✓Map decision points to data sources — for each AHEAD requirement, identify which system holds the relevant data and whether that data is accessible, timely, and trustworthy.
- ✓Identify quick integration wins — the two or three data connections that would give you the most operational visibility in the shortest time. These are the connections that let you start managing like a global budget organization before the formal transition.
- ✓Build a phased roadmap — what to accomplish in 90 days, six months, and twelve months. The roadmap should be sequenced by impact and dependency, not by technical complexity.
This assessment is the foundation. Without it, you risk investing in tools that don't address your actual gaps. Our data strategy practice has conducted these assessments for hospitals at every stage of value-based care readiness.
Check your state’s readiness profile with free public data on RHT Compass AHEAD.
Funding the Work
Several federal funding mechanisms can support AHEAD readiness work. The HRSA Flex Program distributes over $26 million annually through State Offices of Rural Health, with Program Area 2 specifically targeting financial and operational improvement. Many states operate additional grant programs, tax credit incentives, and stabilization funds that can offset readiness investments. The key is connecting your specific readiness gaps to specific funding criteria — which is significantly easier when you've completed a structured assessment that documents exactly what you need. Learn more about our work with rural healthcare organizations.
Start Before You Have To
States are actively selecting AHEAD participants. Hospitals that wait for formal notification to begin readiness work will find themselves behind from day one. The data infrastructure needed for AHEAD isn't built overnight — it requires connecting systems, validating data quality, training staff on new workflows, and building the analytical capacity to manage a global budget in real time.
The hospitals that succeed under AHEAD will be the ones that treated data readiness as a strategic priority long before the payment model changed. They'll have connected their cost, quality, and population data. They'll have tested their analytics against real decisions. And they'll have built the organizational muscle to use data operationally, not just for compliance reporting.
The transition to value-based care has been gradual, but AHEAD represents an acceleration. The time to prepare is now — not when the global budget takes effect.