What's Happening?
The Centers for Medicare & Medicaid Services (CMS) has announced the Long-Term Enhanced ACO Design (LEAD) model, a new 10-year accountable care program set to begin on January 1, 2027, and conclude on December 31, 2036. This initiative follows the conclusion
of the ACO REACH model at the end of 2026. The LEAD model aims to address participation barriers in accountable care organizations (ACOs) by offering enhanced cash flow payments and greater flexibility for providers. It is designed to support a wide range of physicians, including those in community health centers and rural areas, by facilitating regular patient check-ins and improving care coordination. The model includes two risk-sharing options: a global risk option, where participants can receive or be liable for 100% of savings or losses, and a professional risk option, offering 50% of savings or losses. Additionally, CMS plans to test Medicaid integration through the LEAD demonstration, with an initial planning phase starting in March 2026.
Why It's Important?
The introduction of the LEAD model is significant as it represents CMS's longest demonstration project, aiming to enhance the quality of care for Medicare beneficiaries while reducing costs. By addressing barriers to ACO participation, the model seeks to encourage more providers to join, potentially leading to improved healthcare outcomes and reduced hospitalizations. The focus on long-term provider-patient relationships and proactive care coordination is expected to benefit high-needs populations, including dually eligible and homebound beneficiaries. The model's risk-sharing options provide financial incentives for providers to deliver cost-effective care, aligning with broader healthcare reform goals. The potential integration with Medicaid could further streamline care delivery and improve outcomes for a broader patient base.
What's Next?
As the LEAD model prepares for its launch in 2027, CMS will conduct a planning phase to identify states interested in partnering for Medicaid integration. This phase will run from March 2026 to December 2027. Stakeholders, including the National Association of ACOs, have expressed support for the model but also raised concerns about the transition timeline from the ACO REACH model. They have urged CMS to extend the REACH model through 2027 to allow for a smoother transition. As details of the LEAD model continue to emerge, organizations like Accountable for Health (A4H) are keen to collaborate with CMS to ensure the model strengthens primary care and promotes equity.
