Health Care Matters | April 3
CMMI Releases RFA for the Long-Term Enhanced ACO Design (LEAD) Model
CMMI has released the Request for Applications (RFA) for the Long-term Enhanced ACO Design (LEAD) Model, outlining a new approach to accountable care with a 10-year performance period beginning in 2027. The model introduces several structural changes, including updated benchmarking designed to create more stable, long-term incentives, expanded use of capitation payments, and new mechanisms to better engage specialists and support providers caring for high-needs and dually eligible populations.
LEAD also reflects a broader effort to attract a wider range of participants into accountable care, including smaller, independent, and rural providers, while encouraging earlier intervention and preventive care. With features like CMS-administered risk arrangements (CARA) for specialists and increased flexibility in payment and care delivery, the model builds on prior ACO initiatives while attempting to address long-standing challenges related to participation, benchmarking, and sustainability. Read here.
Why It Matters
LEAD reinforces CMMI’s push toward longer-term, more stable accountable care arrangements, with design choices that directly respond to past participation challenges. The 10-year model horizon, more predictable benchmarking, and expanded use of prospective payments signal a clearer expectation that organizations move beyond incremental participation toward sustained care transformation. At the same time, features like CARA and non-primary care capitation reflect a more deliberate effort to bring specialists into risk and better align incentives across the care continuum, an area where prior models have struggled.
For organizations, the opportunity comes with a higher operational bar. LEAD requires more advanced capabilities in governance, compliance, data infrastructure, and financial management, alongside a stronger emphasis on prevention and beneficiary engagement through tools like prevention quality plans (PQPs) and beneficiary enhancements/beneficiary engagement incentives (BE/BEIs). In the near term, decisions will hinge less on interest in value-based care and more on readiness: whether organizations have the scale, infrastructure, and risk tolerance to participate effectively in a more integrated and demanding model.
Look for the Helpers: Innovative Care Models Help Patients Navigate Complex Health Needs
A recent case study highlights a home-based care model that delivers services like chemotherapy directly to patients using remote monitoring, virtual oversight, and mobile care teams, reducing the need for hospital visits. Early results show this approach can safely manage complex treatment at home while improving patient comfort and engagement. The model points to a more scalable, patient-centered way to deliver high-acuity care outside traditional clinical settings. Read here.
What We Are Reading
A Framework for Evaluating Primary Care Investment
A Milbank Memorial Fund analysis proposes a framework for evaluating primary care investment, emphasizing how funding levels translate into access, quality, and long-term health outcomes. Read here.
States Pay Consultants Millions to Implement Medicaid Work Requirements
A KFF Health News article reports that states are spending millions on consultants like Deloitte, Accenture, and Optum to update eligibility systems and comply with new Medicaid work requirements, highlighting the significant administrative and technology burden tied to implementation. Read here.
‘Lifesaving’: ACOs Laud Federal Move to Address Suspect Billing
A Modern Healthcare article reports that CMS will exclude certain billing codes from ACO payment calculations and hold MSSP and ACO REACH participants harmless from billing patterns outside their control, a move that ACO groups support while noting additional changes may still be needed. Read here.
Challenges Confronting State Regulation Of Health Care Prices: Ten Questions
A Health Affairs Forefront article outlines key questions states must consider when regulating health care prices, including how to balance regulatory approaches with market-based strategies and address data, implementation, and oversight challenges. Read here.
HHS Mobile Clinic Pilot Offers a Guide for Rural Access, Revenue
A Modern Healthcare article examines how CMS is encouraging the use of mobile clinics to improve access in rural communities, highlighting their role in delivering preventive and primary care services directly to patients while helping address workforce shortages and gaps in traditional infrastructure. Read here.
What We're Attending
NAACOS Spring 2026 Conference
The NAACOS Spring Conference, taking place April 22–24, 2026 in Baltimore, will bring together ACO leaders, policymakers, and industry stakeholders to discuss the latest developments in accountable care and value-based payment. The agenda includes sessions on emerging CMS models, AI and technology in care delivery, and strategies for navigating evolving payment and benchmarking approaches, including LEAD and other CMMI initiatives. With a strong focus on practical insights and peer learning, the conference offers a timely opportunity to engage on the operational and strategic challenges shaping the future of value-based care. Register here.
Pop Health Podcast
From Concept to Model: The Making of LEAD
In this episode, Coral's Maria Alexander and Joy Chen welcome Meredith Yinger, Model Lead for the Innovation Center’s LEAD (Long-term Enhanced ACO Design) Model and Emily Bezold, Senior Advisor to the Center’s ACO portfolio. Together, they explore more about the mission and vision for LEAD, how the model came to fruition, the Center’s rationale for key design features, and what potential applicants may want to know before they apply.