ACO DESIGN Model
LEAD (Long-term Enhanced ACO Design) Model
LEAD (Long-term Enhanced ACO Design Model) is a new CMS ACO model launching in 2027, designed to expand participation in accountable care particularly among smaller, independent, and rural providers. It introduces improved benchmarking and model design features to better support organizations caring for complex, high-needs populations, including dual eligibles and homebound patients. More broadly, LEAD aims to strengthen value-based care by increasing provider participation, supporting patient choice, and enabling more effective preventative and coordinated care delivery.
overview
How does LEAD compare to other models?
The newly announced LEAD Model, details of which were released in the Request for Applications (RFA) on March 31, 2026, represents CMS’ commitment to design a more stable and inclusive framework to expand participation and advance accountability for cost and quality. For organizations considering ACO participation for Performance Year (PY) 2027, it is critical to understand the key success factors that differentiate LEAD from MSSP and ACO REACH.
Organizations have until May 17, 2026 to respond to the RFA, so it is critical to chart out an ACO strategy today. ACO REACH participants in PY-2026 are eligible to submit an abbreviated application. In addition, organizations interested in future cohorts will have an opportunity to submit a standardized Letter of Interest (LOI), which CMS expects to release no later than April 20, 2026.
insight
Navigating CMMI’s LEAD Model: How Is This Model Different from MSSP and ACO REACH?
Learn more about how we can help build or accelerate success for your IPA, CIN or ACO
suited for established and emerging organizations preparing to invest in long-term care transformation
Who is LEAD a Fit For?
Prior MSSP and ACO REACH Participants
Those who experienced benchmark erosion or unfavorable historical comparisons, LEAD offers a 10-year performance period with no rebasing and a redesigned benchmarking approach that supports long-term financial stability.
Smaller, Independent, Rural, and Safety-net Providers Including FQHCs, CINs, and IPAs
Attractive in provisions of advanced payments, administrative add-ons, and alignment flexibility that support infrastructure growth.
Rural health providers may find LEAD particularly attractive due to this add-on payments and a lower beneficiary alignment minimum. particularly as they look to align their transformation strategy alongside other grants and programs. New entrants and smaller ACOs also benefit from the hybrid alignment approach in LEAD which allows expanding networks to realize attribution growth throughout the year as they form new alliances.
Experienced ACOs Looking to Better Engage Specialists
These can leverage some of the offerings under LEAD, such as CMS-administered episode-based risk arrangements (CARA) and expanded non-primary care capitation options. Specialists themselves may find it advantageous to align with ACOs under LEAD as they coordinate their value-based care strategy alongside complementary programs such as the Ambulatory Specialty Model (ASM).
insight
Inside the LEAD Model Benchmarking Methodology
Learn how LEAD differs as a model to ACO REACH and MSSP.
From Application to Transformation
How We Can Help
Application Strategy and Support
Application, stand up and ongoing administration. The application process can seem daunting. We have the experience and know-how to guide applicants from start to finish. From network formation, governance design to eCQM reporting, we provide the full array of service partner capabilities.
Care Management Program Design and Implementation
Physician participants cannot deliver success on their own. Achieving the best performance requires collaboration with proactive and robust care management resources. We have the expertise to design and implement new programs or simply enhance an existing program.
State and Federal Programming Expertise: Helping You Win
Success in value-based care requires having the right information at the right time and available to the right people. Our proprietary ARC platform unifies disparate data sources into actionable workflows and a comprehensive view of utilization, financial and quality performance.
Integrated Care Models: Improve Health Outcomes
The establishment of strong connectivity between providers and contract level performance enhances accountability and reduces execution risk. By aligning operational objectives in clinical and non-clinical settings with the financial goals of the model, leaders can make informed decisions and allocate resources effectively.
KEY DATES
What is the Application Timeline?
Application Window
March 31 – May 17, 2026: LEAD application window open
May 17, 2026: Application deadline
*Letter of Intent (LOI) due for PY-2028 participation (if not applying for PY-2027)
Selection and Onboarding
Early Summer 2026: Participant selection and onboarding begins
Key Operational Milestones:
- August 5, 2026: Deadline to add participant TINs to rosters
- September 8, 2026: Participant TIN drop deadline
Implementation Period
September 15 – December 31, 2026:
Optional implementation period
Go-Live
January 1, 2027: Performance Year 1 begins
Notes:
*Organizations participating in ACO REACH (PY-2026) are eligible for an abridged application
**Organizations not ready for PY-2027 can submit an LOI for PY-2028 participation
Connect with our Experts
Are You Poised to LEAD or Lag in the New Model?
Whether your organization is a first-time ACO model applicant or an experienced ACO participant, we have the expertise and resources to improve performance and increase shared savings.