New Medicare Accountable Care Organization (ACO) Model Launching January 1, 2027
The Center for Medicare and Medicaid Innovation (CMMI) announced a new Accountable Care Organization model for traditional Medicare beneficiaries, called the LEAD Model (Long-term Enhanced ACO Design). The LEAD model will replace the current ACO Reach model, which is set to end on December 31, 2026. In addition to current ACO Reach participants, the LEAD model will encourage new providers to participate, including those serving a high proportion of dually eligible individuals, Federally Qualified Health Centers, and Rural Health Clinics. More information about the model's payment details and quality measures will be released soon, but it maintains a goal of improving quality and reducing unnecessary emergency department visits and hospitalizations.
New features of the LEAD model also include CMS Administered Risk Arrangements (CARA), which is intended to support episode-based payments and risk arrangements between the ACO and their Preferred Providers and specialists. Further, CMMI is planning new ways to incentivize and target care for beneficiaries with complex needs. Together, these two features may create new opportunities for palliative care programs to secure sufficient financing for their services to ACO patients. As with other CMMI models, current Medicare requirements may be waived under the LEAD model, although there is no information yet on whether concurrent hospice benefits will continue in the new model.