The Centers for Medicare & Medicaid Services’ (CMS) Innovation Center on Dec. 18 announced the next Accountable Care Organization (ACO) model that will build off prior ACO tests, with the intention of appealing to providers with specialized patient populations and those new to ACOs. The Long-term Enhanced ACO Design (LEAD) Model will begin Jan. 1, 2027, and ACOs can apply to participate through a request for applications available in March 2026. The LEAD model will run for 10 years, the agency’s longest ACO test, which the CMS believes will provide participating ACOs predictability without rebasing financial benchmarks. ACOs in the model will have two risk options for receiving savings or paying back losses to their benchmarks: Global Risk (up to 100%) and Professional Risk (up to 50%). Notably, the model introduces a new CMS Administered Risk Arrangement (CARA) initiative, which will “provide robust CMS support to ACOs to enable episode-based risk arrangements between ACOs and their specialists and provider organizations.” The announcement also highlighted model options for enhancing Medicare patients’ benefits and engaging patients, including cost sharing support and a future Part D premium buy down.
- Washington Highlights