The Trump administration has revealed what comes next when the ACO REACH model concludes at the end of 2026.
The Center for Medicare and Medicaid Innovation unveiled the Long-Term Enhanced ACO Design, or LEAD, model Thursday as its newest accountable care program. LEAD will be a decade-long voluntary program that begins Jan. 1, 2027 and concludes Dec. 31, 2036.
The model is the longest demonstration that the Centers for Medicare & Medicaid Services (CMS) has ever conducted, according to the agency's website.
The CMMI said LEAD is designed to address the barriers to participation that can lead to attrition or prevent providers from joining an ACO at all. Both established and new ACOs will receive enhanced and flexible cash flow payments and will have greater freedom to spend time with patients.
Abe Sutton, director of the CMMI, said in a promotional video that the model is built to support a broad array of physicians, including community health centers and rural docs who may not have been able to participate in an ACO otherwise. A key goal is to make it easier for providers to check in regularly and proactively with patients between visits to better coordinate care, Sutton said.
"LEAD is designed to make care more connected, more proactive and more centered on what patients with Medicare truly need," he said. "It focuses on long-term relationships between providers and patients."
The CMS said the model will include two risk-sharing options for participants. Under the global risk option, participants are eligible to receive back 100% of generated savings and will be liable for 100% of losses based on their performance benchmark.
In the professional risk option, meanwhile, providers can receive 50% of generated savings and will be responsible for 50% of losses related to benchmarks.
The CMS also intends to test Medicaid integration through the LEAD demonstration, per the website. The agency will kick off an initial planning phase in March 2026 to run through December 2027 in which it aims to identify two states that want to partner on building a framework collaboration between Medicaid programs and accountable care organizations.
If that planning window is wrapped up successfully, ACOs in those two states can then go on to partner with Medicaid organizations.
"This framework will help define how ACOs and Medicaid organizations can work together to share data and coordinate care to improve outcomes, including preventing avoidable hospitalizations and help patients remain engaged in their communities," the CMS said on the website.
The agency will also implement CMS Administered Risk Arrangements, or CARAs, under the model, which will allow ACOs to establish episode-based arrangements with specialty providers and other downstream members of the care team, according to the site.
Advocacy group Accountable for Health (A4H) said in a statement that it "welcomes" the LEAD model as it aims to tackle key challenges that can dampen ACO participation.
"We are particularly encouraged that LEAD preserves a dedicated focus on high-needs populations, including dually eligible and homebound beneficiaries, which has been critical to the success of many high-performing ACOs under REACH," A4H said.
"As details continue to emerge, A4H looks forward to working with CMS to ensure the model strengthens primary care, promotes equity, and creates a sustainable pathway for providers to deliver better outcomes and lower costs for Medicare beneficiaries," the organization said.
The National Association of ACOs (NAACOS) expressed similar support for the new model. Emily Brower, president and CEO of NAACOS, said in a statement that the 10-year length of the demonstration "will allow participants to move past implementation to develop long-term investments and meaningfully innovate strategies that help move the transition to accountable care forward."
However, the group did express concern about the time ACO REACH participants will have to make the switch to LEAD and urged the CMS to extend the REACH model through 2027 to allow for an easier off-ramp into the new program.
"While these components will be beneficial to participants in the long run, launching the model in 2027 does not provide ACO REACH participants with enough time to evaluate alternative payment models options and effectively plan their transition," Brower said.