LEAD
Long-term Enhanced ACO Design Model
The Long-term Enhanced ACO Design (LEAD) Model is the Innovation Center’s newest Accountable Care Organization (ACO) focused model, set to launch following the conclusion of ACO REACH at the end of 2026. It utilizes improved benchmarking to appeal to a broader mix of health care providers, including those with specialized patient populations and those new to ACOs. With a 10-year performance period, LEAD offers a predictable window without rebasing and a pathway toward sustainable long-term benchmarks and savings.
Innovation
With a 10-year performance period — the longest CMS has ever tested — LEAD offers a predictable window without rebasing and a pathway toward sustainable long-term benchmarks and savings.
The Problem
Many health care providers have not historically participated in or dropped out of ACOs because of financial and administrative obstacles to success.
The Solution
LEAD is designed to address such barriers to support both established and newly created ACOs by providing them enhanced, flexible cash flow payments; and greater freedom and tools to support spending time with and meeting patient needs, including those with specialized care needs.
Expected Outcomes
Through ACOs, health care providers will be empowered to deliver coordinated, accountable care and preventive services — keeping patients healthier and helping to reduce health care costs and unnecessary emergency room visits and hospitalizations.
Strategy
LEAD advances the Innovation Center’s commitment to 1) building opportunities for independent health care providers and practices to be rewarded for delivering better care, 2) promoting and empowering patient choice in both coverage and sites of care, and 3) making it easier for health care providers and patients to engage in preventive care that supports healthier living.
Model Goals
- Appeal to a broader mix of health care providers, including those with specialized patient populations and those new to ACOs
- Better serve coordinated care for high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited
Patient Eligibility
Focuses on high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited.
- Dually eligible for Medicare and Medicaid
- Homebound or home limited
Provider Eligibility
Accountable care organizations, including established and newly created ACOs, smaller, independent or rural-based practices, and those with specialized patient populations.
- Accountable care organizations
Care Categories
Population Health
CMS Benchmarks & Thresholds
operational
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