Long-term Enhanced ACO Design Model Overview

This guide provides a detailed overview of the Long-term Enhanced ACO Design (LEAD) model, which is the next-generation accountable care model from the Centers for Medicare and Medicaid Services (CMS), set to begin on January 1, 2027. The LEAD model is a voluntary, 10-year initiative aimed at enhancing total cost-of-care accountability while improving financial sustainability for organizations serving complex Medicare populations. It introduces two voluntary risk tracks, Global and Professional, and eliminates benchmark rebasing over its duration. The guide outlines how LEAD enhances previous models by integrating high-needs beneficiaries, improving payment accuracy, and supporting Medicaid coordination. It also details the payment model, which includes total cost of care and introduces a new non-primary care capitation option. Additionally, the guide discusses quality performance measures and beneficiary support initiatives, highlighting the model's emphasis on predictability and scalability. The document concludes with a comparison of LEAD and its predecessor, ACO REACH, detailing key differences in participation requirements and program focus.