In our recent LEAD Readiness Room webinar, industry leaders and current ACO REACH participants shared insights, lessons learned, and key questions around the opportunities and uncertainties within LEAD.

Here are the key themes from the discussion, framed through the questions top of mind for attendees.

What do you find most exciting about the new model?

One of the most compelling aspects of ACO LEAD is the continuation and expansion of financial and operational flexibility. Two major carryovers from REACH stand out:

• Global risk opportunities, allowing organizations to capture first-dollar savings
• Primary care capitation, which introduces upfront cash flow

Together, these enable organizations ready to take on risk to access savings earlier and reinvest directly into care delivery—rather than waiting 18 months for reconciliation as in traditional MSSPs. This shift fundamentally improves liquidity and supports more proactive patient care strategies.

Another major advancement is the integration of high-needs beneficiaries across all LEAD ACOs. Unlike REACH where this population was limited to specific tracks, LEAD embeds high-needs patients into every model participant. These patients come with:

• Distinct risk adjustment methodologies
• Dedicated target pricing

This creates new opportunities and incentives for organizations to better serve complex, high-cost populations.

How does LEAD expand opportunities for specialty engagement?

LEAD introduces new mechanisms to bring specialists more meaningfully into value-based care:

• CARA (CMS-administered risk arrangements): Nested bundled payment structures that support specialty care alignment
• Non-primary care capitation options: Allowing ACOs to provide upfront payments or capitation to specialists

These tools are unique to LEAD and not broadly available in other ACO models. As highlighted by webinar participants, specialties like cardiology and pulmonology—which manage high-cost chronic populations—represent a major opportunity to improve both outcomes and financial performance.

What lessons from ACO REACH should organizations carry forward?

Participants emphasized several key lessons:

1. Quality performance remains foundational. Strong performance on HEDIS and quality metrics will continue to directly impact both outcomes and financial success.
2. Fully utilize benefit enhancements. While some organizations effectively used tools like the 3-day SNF waiver, others acknowledged underutilization of home-based care, telehealth, and hospice services. More intentional use of these benefits can improve patient experience and reduce avoidable utilization.
3. Care coordination is critical. Successful REACH participants invested heavily in:

• SNF partnerships and performance tracking
• Nurse navigation and hospital coordination
• Early patient identification in emergency settings

These capabilities will remain essential and likely expand under LEAD.

What are the biggest concerns about LEAD?

Despite the excitement, uncertainty around some of the unknowns of the new model remains a major theme.

Many organizations are grappling with the transition to a rate book methodology, which introduces:

• Regional benchmarking comparisons
• “Bell curve” style performance positioning
• Uncertainty in where an ACO will land financially

Additionally, CMS plans to introduce new risk adjustment approaches, including AI-informed methodologies, which are not yet fully defined.

An ACO’s designation as high-cost or low-cost significantly impacts financial incentives—but determining where an organization falls is complex, especially with varying proportions of high-needs patients and new stratification methodologies (e.g., ABD vs. ESRD vs. high-needs carve-outs).

The good news: there is no penalty for misclassification during application, as CMS will ultimately assign categories.

How should organizations approach high-needs patient management under LEAD?

The answer starts with identification and infrastructure.

Key priorities include:

• Advanced risk stratification to quickly identify high-cost and rising-risk patients
• Technology integration, including EMR and HIE connectivity
• Patient engagement tools to ensure individuals are connected to appropriate care programs
• Strong documentation and coding practices, especially as new risk adjustment methodologies emerge

Organizations should also focus on:

• Integrating social determinants of health (SDOH) data
• Identifying “rising-risk” patients early to prevent escalation
• Leveraging waivers and care models tailored to patient needs

If given six months to prepare, what would you prioritize?

Speakers were consistent: start with the foundation.

Top priorities:

1. Financial modeling: Understand your potential performance under LEAD, especially within the rate book framework.
2. Provider network alignment: Ensure your participating providers are engaged, aligned, and clearly defined.
3. High-needs patient strategy: Focus early on this population, as it represents both the greatest cost and the greatest opportunity.
4. Infrastructure readiness: Build on REACH capabilities where possible but adapt for LEAD’s expanded requirements.

Clinical program expansion can follow—but only after these core elements are in place.

Should organizations rethink TIN structures and how their alignment impacts potential program success?

Potentially—but cautiously. Adjusting TIN structures can:

• Influence whether an ACO is classified as high- or low-cost
• Impact financial benchmarks and performance comparisons

However, frequent or significant changes may introduce unintended consequences. Organizations should carefully evaluate TIN alignment within the broader context of their long-term strategy.

Final Thoughts: A Model Full of Opportunity—With Some Unknowns

LEAD represents a meaningful evolution in value-based care, offering:

• Greater flexibility in risk and payment models
• Expanded tools for specialty and patient engagement
• Increased focus on high-needs populations

At the same time, uncertainty, particularly around financial modeling and methodology remains a key concern. What’s clear is that CMS is committed to making LEAD successful, learning from past models like NextGen and REACH. For organizations prepared to invest in infrastructure, analytics, and care transformation, LEAD presents a significant opportunity to improve both patient outcomes and financial performance.

COPE Health Solutions partners with organizations nationwide to navigate complex CMS models, including LEAD and MSSP, bringing together financial modeling, network design, and care delivery transformation to drive success. For organizations exploring LEAD, evaluating MSSP, or assessing the strategic impact of these models, our team helps translate uncertainty into clear, actionable plans.

To move from strategy to sustained performance, having the right foundation is critical. COPE Health Solutions’ ARC platform enables population health and value-based care capabilities that empower ACOs to turn insight into action, supporting smarter decisions and long-term results.

If you’re evaluating your next step in value-based care, we welcome the opportunity to connect and support your ACO journey.