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A ten-year federal program designed to transform care delivery for Medicare beneficiaries through accountable, coordinated care.
The Long-term Enhanced ACO Design Model — known as LEAD — is the newest Accountable Care Organization model from the Centers for Medicare & Medicaid Services (CMS). It was announced in December 2025, with the first performance year beginning January 1, 2027.
The LEAD Model is administered by the CMS Innovation Center and replaces the ACO REACH Model, which ends December 31, 2026. City Care Partners has been accepted to participate in the LEAD Model and will begin our first performance year on January 1, 2027.
The LEAD Model represents a fundamental shift in how the federal government approaches value-based care — moving away from short-term, frequently changing programs toward a long-term framework that gives providers the stability to make meaningful investments in care transformation.
The LEAD Model introduces several significant changes designed to make accountable care more accessible, more stable, and more effective.
Unlike prior programs, the LEAD Model commits to a ten-year horizon, allowing participants to make long-term investments in care transformation without the disruption of frequent program changes or benchmark rebasing. This stability is critical for building infrastructure, earning provider trust, and compounding improvements over time.
Reduced alignment minimums, rural add-on payments, and softened certification requirements make participation accessible to independent and rural primary care practices that have historically been excluded from value-based care. The LEAD Model was explicitly designed to bring these practices into the fold.
The LEAD Model introduces specialized risk adjustment and care delivery frameworks for beneficiaries with serious or complex conditions, ensuring that complex patients are served well rather than avoided. This addresses one of the most significant shortcomings of prior ACO models.
The CMS Administered Risk Arrangements framework gives ACOs and specialists structured templates for episode-based value arrangements, accelerating the inclusion of cardiology, nephrology, oncology, orthopedics, and other specialties in accountable care.
The LEAD Model includes mechanisms to reduce certain out-of-pocket costs for beneficiaries, including Part B cost-sharing support and, by 2029, Part D premium reduction options. These incentives encourage beneficiary engagement and reward high-quality care.
Performance benchmarks remain stable over the ten-year period rather than resetting every few years. This gives providers confidence that the investments they make in care improvement will translate into shared savings over time, rather than being eroded by moving targets.
The LEAD Model addresses key limitations of earlier federal ACO initiatives.
| Feature | Prior ACO Models | LEAD Model |
|---|---|---|
| Performance Period | 3 years (with renewal cycles) | 10 years, single commitment |
| Benchmark Stability | Rebased every 3 years | Stable for entire 10-year period |
| Alignment Minimums | Higher thresholds excluded small practices | Reduced minimums for small/rural practices |
| Specialty Integration | Limited, required custom contracting | CARA templates for episode-based arrangements |
| High-Needs Populations | Risk adjustment sometimes penalized complex patients | Specialized frameworks for complex conditions |
| Beneficiary Cost Support | Minimal direct benefits to beneficiaries | Part B & Part D cost-sharing reductions |
| Rural Practice Support | Limited add-ons or accommodations | Dedicated rural add-on payments |
One of the most significant innovations in the LEAD Model is the CMS Administered Risk Arrangements (CARA) framework. For the first time, CMS has created standardized legal and operational templates that allow ACOs to establish episode-based value arrangements with specialty practices.
This means specialists in fields like cardiology, nephrology, oncology, and orthopedics can participate in value-based care without negotiating complex, custom contracts for each arrangement.
Official resources from the Centers for Medicare & Medicaid Services about the LEAD Model.
The official CMS resource page for the LEAD Model, including fact sheets and guidance documents.
Visit CMS PageOverview of the CMS Innovation Center and its portfolio of value-based care models.
Explore the Innovation CenterFrequently asked questions about the LEAD Model from CMS, covering provider, beneficiary, and operational topics.
Read the FAQWhether you're a Medicare beneficiary, a primary care provider, or a potential partner, we're here to help you understand what the LEAD Model means for you.
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