The newly announced Long-term Enhanced ACO Design (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.

In One Sentence Each

• MSSP – The broad, flexible entry point into value‑based care for original FFS Medicare.
• ACO REACH – The full‑risk, equity‑focused model for advanced organizations.
• LEAD – CMS’s next‑generation, capitation‑driven, specialist‑integrated, high‑needs‑focused ACO model.

Below is a table summarizing the key differences between the models:

How COPE Health Solutions Can Help

Organizations should assess where they fall along the value-based care maturity spectrum and choose the model that fits best. Given LEAD’s requirement to take some level of downside risk upon entry, participation in the program will require thoughtful preparation across several areas. Organizations should evaluate:

• Financial readiness, including the ability to manage downside risk from the get-go and model performance under new benchmarking methodologies
• Operational capabilities, such as care coordination, population health management, and high-needs patient engagement
• Data and technology infrastructure, including readiness for evolving quality reporting requirements
• Governance and compliance structures, aligned with CMS expectations for ACO oversight and accountability

COPE Health Solutions supports clients across the full lifecycle of ACO participation, including:

• Strategic advisory to decide best fit model for your organization and at key decision deadlines throughout 2026
• Financial assessments and scenario modeling to evaluate performance under various tracks and capitation/quality decisions in each model
• Network development, funds flow and provider recruitment/relations, including specialist integration, to establish strong ACO governance and provider alignment
• Care model design, build and/or configuration to service a High Needs population, including home-based primary care
• Quality/HCC gap closure to meet model goals of true prevention
• Data integration and real-time analytics
• Business and operational readiness evaluations aligned with CMS application criteria
• Implementation and ongoing ACO operations and compliance support to maximize performance

With the LEAD application window already underway, organizations should act now to assess their readiness and define their path forward; those interested in a PY 2027 start with LEAD should begin readiness assessments and applications immediately. COPE Health Solutions is ready to support your journey into the next generation of accountable care.

Contact info@copehealthsolutions.com to schedule a briefing to get started.