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.
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.
To learn more about how LEAD compares to MSSP and ACO REACH, see the recent article here:
Navigating CMMI’s LEAD Model: How Is This Model Different from MSSP and ACO REACH?
Who is LEAD a fit for?
LEAD is a strong fit for both experienced ACOs and organizations new to accountable care.
For prior MSSP and ACO REACH participants that 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.
At the same time, the model is intentionally structured to attract smaller, independent, rural, and safety-net providers including FQHCs, CINs, and IPAs by providing 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 can also 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).
Overall LEAD appears to be well suited for both established and emerging organizations preparing to invest in long-term care transformation.
What is the application timeline?
LEAD PY-2027 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
Ready to get started?
The timeline to evaluate your options and prepare for what’s next is short. Many teams we’re talking with are finding it difficult to fully assess their opportunity while also preparing for a seamless transition. We’re working with teams across the country to:
- Compare LEAD and MSSP based on their specific performance and risk profile
- Model their financial opportunity under each model
- Support transition planning and the application process
Complete the form above to schedule a briefing with our LEAD expert team.
