CMS is launching its long-term enhanced accountable care organization design, or LEAD, model at the end of 2026, following the conclusion of the ACO realizing equity, access and community health model.
Previously, CMS set a goal to have all traditional Medicare beneficiaries in an accountable care relationship by 2030. ACO REACH currently offers a shared-savings model with a focus on health equity and requires participants to be at least 75% provider governed.
Here are six things to know about the forthcoming LEAD model:
1. This model aims to be “more inclusive” of smaller, rural and independent practices.
2. The model is working toward “more accurate risk adjustment and benchmarking” to account for high-needs patients.
3. LEAD will offer two voluntary risk-sharing options: ACOs can either retain up to 100% of savings if spending is below benchmark and be held responsible for 100% if spending is over that benchmark, or they can keep up to half the savings and carry up to half the losses.
4. To better understand how to integrate Medicaid and Medicare services, LEAD will determine two states to assist with developing a framework for ACO-Medicaid partnership arrangements.
5. The model allows ACOs to incentivize beneficiaries to seek out care, such as Part B cost-sharing support and eventually a Part D premium buy-down.
6. The CMS Administered Risk Arrangements initiative will support episode-based risk arrangements among ACOs, specialists and provider organizations to foster stronger relationships, along with an episode-based falls prevention program.
