Initiative One

Initiative One: Transforming for a Sustainable Health System in Rural Georgia RHT Program 

• RHT Program Strategic Goal: Innovative Care

• GREAT Health Vision Alignment: Needs for Rural Progress

Innovations in healthcare delivery, quality, payments, and long-term systemic sustainability are within reach for Georgia as preparation gets underway for future application and desired participation in the AHEAD (Achieving Healthcare Efficiency through Accountable Design) model. This model supports innovative healthcare by transforming how care is paid for, delivered, and measured, especially at the state, hospital, and primary care levels. By aligning incentives across payers, AHEAD enables states and providers to innovate in care delivery and population health. Benefits are shown in Table 4.

Table 1: Overall Benefits of the AHEAD Models for Rural Communities

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.

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 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 would include strategies to:

1. Conduct a statewide financial and technological assessment of all eligible model participant sites; 

2. 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; 

3. Receive funds to initiate projects to ensure long-term success of AHEAD model participation; and 

4. 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.

The following are key outcome metrics associated with this initiative. Additional metrics are included in the Metrics and Evaluation plan section. Unless otherwise indicated, baseline measures are zero and will be established at Year 0 of the program; the proposed outcomes will be observed by FY31. 

Outcomes

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%).

Overall Funding for this Initiative

$56,750,000 in Budget Period 1.

Table 2: Strategies of Transforming for a Sustainable Health System in Rural Georgia 

Subtitle: AHEAD Model Assessment, Consideration, and Preparation.

This table was reformatted as an ordered list for better readability.

• Use of Funds:
  • D. Training and Technical Assistance, G. Appropriate Care Availability, I. Innovative Care
• Technical Score Factors:
  • C.1. Rural Provider Strategic Partnerships
  • E.1. Medicaid Provider Payment Incentives 
  • E.2. Individuals dually eligible for Medicare and Medicaid
• Key Stakeholders:
  • All provider types in rural areas, community-based organizations, FQHCs, hospitals, patients, SORH.

Measurable Outcomes:

• Number of rural hospitals participating in the AHEAD program (desired trend increase)
• Number of rural primary care providers participating in the AHEAD program (desired trend increase)

Counties Impacted:

• 126 HRSA-rural Georgia counties or portions of counties.

Sustainability Efforts 

The Transforming for a Sustainable Health System in Rural Georgia initiative will prepare Georgia’s hospitals, providers, and payers for participation in the AHEAD models. 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. In addition, funds spent in RHT Program years four and five to mitigate hospitals’ losses during AHEAD years one and two as they adjust to global payments will ensure a more successful transition to the new funding structures of the model. By maximizing the potential for the AHEAD model to succeed into the future, Georgia can revolutionize how healthcare is delivered in rural communities and ensure its viability and availability for successive generations.

The combined strategies of the GREAT Health Program Transforming for a Sustainable Health System in Rural Georgia initiative and the RHT Program Innovative Care strategic goal support Georgia’s objective of ensuring a future in which all rural Georgians will benefit from innovations in healthcare delivery that improve quality health outcomes and quality of life.