WASHINGTON — The planned new Long-term Enhanced ACO Design (LEAD) Model, unveiled today by the Center for Medicare and Medicaid Innovation (CMMI), could be an important means of drawing new entrants into value-based care as well as a path forward for organizations currently participating in ACO REACH, America’s Physician Groups said today. “The ACO REACH (Realizing Equity, Access, and Community Health) model is set to expire at the end of 2026, and LEAD has multiple elements that may appeal to many of our member organizations as they consider their next steps in the pursuit of accountable care for 2027 and beyond,” said Susan Dentzer, president and chief executive officer of APG.
According to information released today by CMMI, the LEAD model could address many longstanding concerns of organizations that have participated in ACO REACH and other accountable care models. Among the features that are most appealing in the LEAD model, as described by CMMI, are these:
- A 10-year performance period that could provide greater stability and predictability for physician groups than has typically been the norm for CMS and CMMI models;
- Performance benchmarks that are to be set initially and maintained for the entire model period, rather than being “rebased” periodically, as is typical of most accountable care models;
- More accurate risk adjustment and other features that will better support physician organizations’ abilities to care for complex, high-needs patients, integrating them fully into the ACO rather than caring for them under a separate ACO track; and
- Support from CMS to enable participating ACOs to have episode-based risk arrangements with specialists – a key step in enhancing accountability across providers and the full spectrum of health care.
- The opportunity to offer incentives for beneficiaries to participate in LEAD ACOs, including through cost-sharing for Medicare Part B services and “buying down” their Medicare Part D premiums as of 2029.
“APG’s members and the broader accountable care community will be interested to receive more details about these and other aspects of the LEAD model,” Dentzer said, and will look forward to responding to the agency’s request for applications beginning next March. In the meantime, APG will organize informational sessions to educate its members about features of the new model.
About America’s Physician Groups
APG’s approximately 340 physician groups comprise nearly 260,00 physicians and other clinicians providing care to nearly 90 million patients, including about one in four Americans and one in three Medicare Advantage enrollees nationwide. APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org. ###
