CMS is moving with precision—and urgency—to reconfigure how care is delivered, funded, and measured across the U.S. healthcare system. With a slate of newly launched state-federal initiatives—AHEAD (All-Payer Health Equity Approaches and Development), IBH (Innovation in Behavioral Health), and TMaH (Transforming Maternal Health)—the agency is signaling a powerful shift: states are no longer observers of reform. They are now architects.

For healthcare leaders, these programs are more than compliance checkboxes. They are an opportunity to align enterprise strategy with the direction of national policy—and to accelerate care delivery models built for long-term sustainability, equity, and performance.

This article breaks down the intent and mechanics of each initiative, identifies the implications for providers and payers, and outlines the strategic moves leaders should be making now.

Why These Models Matter

Each initiative targets a distinct pain point in the U.S. healthcare system—but all share common DNA:

• They are state-driven but federally supported, putting execution power closer to where care happens.
• They are value-oriented, prioritizing outcomes over volume.
• They are equity-aligned, explicitly focused on closing gaps in access and outcomes.

CMS isn’t experimenting. It’s building policy scaffolding for the next decade of healthcare reform—layered with accountability, flexibility, and population-specific targets.

Let’s break them down.

AHEAD: Aligning the System Around Health Equity

AHEAD is CMS’s boldest attempt yet to shift entire state systems toward value-based, population-level health improvement. It’s an all-payer model—meaning it brings Medicaid, Medicare, and commercial payers to the same negotiating table.

Participating states will develop global budgets for hospitals, invest in community-based care infrastructure, and focus on addressing social drivers of health. CMS will provide funding, technical support, and regulatory flexibilities to states that commit to the model.

So, why does it matter?

Global budgets have long been a powerful—yet underutilized—tool for controlling hospital costs while supporting innovation in care delivery. AHEAD brings that tool into the national spotlight, giving states the mechanisms and incentive structures to:

• Coordinate across payers for aligned incentives
• Invest in preventive and wraparound services
• Rebalance care delivery toward long-term population health goals

CMS wants to decentralize accountability—and put budget authority and care transformation in the hands of local leaders. This will reward provider systems that can prove value across populations, not just episodes.

IBH: Rewiring Behavioral Health Delivery

The Innovation in Behavioral Health (IBH) model is CMS’s response to one of the most fragmented and underperforming areas in U.S. healthcare: mental health and substance use disorder (SUD) treatment.

Slated to launch in 2026, IBH focuses on integrating behavioral health with physical health, emphasizing care coordination, data sharing, and alternative payment models for community-based behavioral health providers.

The behavioral health system has traditionally operated in isolation—both clinically and financially. IBH aims to correct this by enabling behavioral health providers to:

• Participate in value-based payment models
• Access care coordination tools and data infrastructure
• Improve continuity and quality of care for high-need patients

CMS is explicitly acknowledging that behavioral health outcomes are foundational to physical health outcomes—and is making structural changes to reflect that. Providers and payers that continue to silo behavioral health will be at increasing odds with national policy and reimbursement trends.

TMaH: Rebuilding Maternal Health from the Ground Up

Transforming Maternal Health (TMaH) is CMS’s latest initiative to address the unacceptable disparities in maternal outcomes, particularly for Black and Indigenous women.

The model supports states in designing whole-person, team-based care for pregnant and postpartum individuals, with a focus on integration, early risk identification, and continuity across prenatal and postpartum periods.

The U.S. has the highest maternal mortality rate among high-income countries—and rates are rising. TMaH provides states with the tools and funding to:

• Expand access to midwifery, doula services, and home visiting
• Build coordinated care pathways across providers
• Track and address racial disparities through targeted quality metrics

Use Case Example

Jaya’s pregnancy journey, as illustrated by the CMS TMaH model, highlights a coordinated, person-centered approach to maternal care. Managing Type 2 diabetes and housing insecurity, she receives integrated support from a team including a midwife, doula, doctor, and social worker. This team helps her navigate medical care, secure housing, and access nutrition and parenting resources. Continuous support through pregnancy, delivery, and postpartum—including telehealth and home visits—leads to healthy outcomes for both Jaya and her baby. The TMaH model demonstrates how holistic, team-based care can effectively address medical and social needs.

What It Signals

CMS is shifting from monitoring disparities to engineering systems that actively prevent them. Organizations that can demonstrate maternal care innovation, equity-focused care models, and scalable outcomes will be positioned as leaders.

Strategic Implications for Healthcare Leaders

The message is clear: the federal government is seeding the ground for localized, accountable, and equity-focused transformation. For executives, this raises key strategic questions:

1. Are You Aligned with State Policy?

If your operations span multiple states—or you rely on Medicaid and Medicare contracts—you’ll need to track state-level CMS model participation closely. Your organization’s relevance and revenue will increasingly be tied to state-selected frameworks and their performance requirements.

Action: Appoint cross-functional policy liaisons to engage with state agencies and model steering groups. Alignment starts with awareness.

2. Can Your Infrastructure Support Multi-Payer Models?

Each initiative emphasizes payer alignment and shared outcomes. This requires operational agility across claims systems, EHRs, population health tools, and risk adjustment engines.

Action: Assess your ability to ingest, normalize, and act on data from multiple payers—then invest in interoperability and governance to fill gaps.

3. Are Your AI and Analytics Capabilities Ready?

CMS’s models demand real-time insight into performance metrics—particularly around health equity, maternal outcomes, and behavioral health utilization. Static dashboards won’t suffice.

Action: Implement agentic AI frameworks that automate data synthesis, detect risk patterns, and recommend interventions across clinical and operational workflows.

4. Are You Positioned to Lead—or Follow?

As these models roll out, healthcare organizations will fall into two categories: those shaping implementation, and those reacting to it. Being proactive isn’t just a cultural trait—it’s a market advantage.

Action: Build internal readiness teams that bring together clinical leaders, data scientists, community partners, and payer relations. Strategy is only useful when it’s executable.

Why Agentic AI and Data Modernization Are Critical Enablers

Behind each CMS initiative is a shared demand: data fluency and execution speed. Traditional systems—fragmented, slow, and siloed—won’t meet the expectations of real-time performance monitoring and adaptive workflows.

This is where agentic AI and modern digital architecture deliver outsized value:

• AI agents can flag disparities in maternal outcomes, behavioral health gaps, or cost overruns—then trigger workflows to intervene.
• Automated data pipelines ensure compliance reporting isn’t a fire drill but a daily capability.
• Scalable platforms enable integration with evolving state requirements without disrupting clinical operations.

These aren't just technical upgrades. They're strategic capabilities that allow organizations to thrive inside value-based, state-led ecosystems. To see how you can rapidly bring AI into any function in your organization, explore our AI Agent Accelerators. Designed to fit into your existing systems with ready-to-use tools and fast deployment, your can start to see value from AI agents in weeks. 

Rapid Adaptation Is the Advantage to Win the Race

CMS is setting the stage for a more aligned, accountable, and equity-focused system—but it’s not prescribing every move. That’s up to the organizations that operate on the ground.

Those who prepare early, build infrastructure with foresight, and align with state leadership will not only comply—they’ll shape the next phase of U.S. healthcare.

The future is not uniform. It will be defined state by state, system by system, and strategy by strategy.

The question for healthcare leaders is simple: Are you ready to help design it—or will you be racing to catch up?