Transitioning the state’s rural healthcare ecosystem to a value-based model of care is described as the “north star” of the Georgia Rural Enhancement And Transformation of Health (GREAT), the state’s $218.8 million federally approved program to bolster rural health. 

More than 85 hospitals have signed letters of intent to participate in the state's new rural value-based care model, which the state envisions as a version of the CMS Innovation Center's Achieving Healthcare Efficiency through Accountable Design (AHEAD) model. 

Six states (Maryland, Vermont, Connecticut, Hawaii, Rhode Island, and New York) already participate in the CMS AHEAD model, which seeks to transform how care is paid for, delivered, and measured, especially at the state, hospital, and primary care levels. By aligning incentives across payers, AHEAD seeks to enable states and providers to innovate in care delivery and population health.

The first initiative in the GREAT Health program is making $56.7 million available to help prepare rural healthcare facilities and Georgia to succeed in this multi-payer value-based model of care. The state’s strategy is to dedicate resources to work with healthcare facilities and leaders to assess readiness, identify gaps, provide technical assistance, and mitigate fiscal risk, particularly for already vulnerable hospitals and small rural clinics. 

The Georgia Department of Community Health is leading the AHEAD effort. It notes that to prepare for participation in the AHEAD Hospital Global Budget Model, hospitals and state agencies will need to undertake a series of strategic, operational, and technical steps. Money spent assessing rural hospitals for capacity and financial viability and determining prerequisites for primary care participation will mean that AHEAD model funding from CMS can be spent more efficiently once the model is implemented.

Because AHEAD is a state-led, multi-payer model, preparation involves coordination between state government, hospitals, payers (Medicaid, Medicare, and private insurers), and community stakeholders. Likewise, to prepare for the Primary Care Model, primary care providers, including FQHCs and CCBHCs, and state agencies, need to discuss how those providers will fit into the model and what they need to do to prepare for participation.

The GREAT Health Program will seek to make it possible for more rural hospitals, providers, and payers to participate in the AHEAD model, mitigate their start-up costs, and increase the provision of primary care and prevention services in rural counties that participate in the model.

Specifically, the GREAT Health Program will include strategies to:
• Conduct a statewide financial and technological assessment of all eligible model participant sites; 
• Provide grants to bring on technical support and project management for Years 2–5 which will represent a shift in focus from the Rural Stabilization Grants in Year 1; 
• Receive funds to initiate projects to ensure long-term success of AHEAD model participation; and 
• Be eligible for risk mitigation funds for RHT Program Years 4 and 5 to allow for real-time experiential learning to encourage long-term success of global budgeting.

GREAT said the outcomes of this initiative will be measured by: rural hospital participation in AHEAD (target is 10% of rural hospitals); primary care providers participating in AHEAD (target is 100); private payers participating in AHEAD (target is 2); and an increase in number of patients participating in annual wellness visits at the county-level (target is 10%).