This Wakely white paper presents the LEAD (Long-term Enhanced ACO Design) Model as CMS’s next-generation approach to accountable care, distinguished from ACO REACH and MSSP by several key structural and financial changes. Running from 2027–2036, LEAD introduces major design elements including eliminating rebasing (locking in base years), expanding capitation and specialist risk-sharing (via NPCC and CARA), integrating high-needs populations into a unified ACO structure, and offering more flexible alignment mechanisms. It also evolves benchmarking through blended trends and a future shift to administratively set regional rate books, while strengthening quality incentives and prevention-focused benefits. Overall, LEAD aims to create a more stable, scalable, and incentive-aligned framework for value-based care, while requiring providers to take on sustained financial risk, invest in care transformation, and carefully assess their readiness for long-term participation.
