©2026 The Health Transformation Advisory. All Rights Reserved.
Our Advisors
Value-Based Care Initiative
The next era of accountable care is here.
The ACO LEAD Model — Long-term Enhanced ACO Design — is CMS's most ambitious accountable care program yet, designed to make value-based participation sustainable, accessible, and rewarding for the long run.
About LEAD
LEAD succeeds the ACO REACH program and addresses the structural barriers that limited its reach. With a fixed 10-year benchmark — no rebasing — and enhanced upfront cash flow, the model is built to reward long-term investment in care quality rather than penalize success. It's the longest-running ACO demonstration model in CMS history.
Key Advantages
#1
Fixed 10-year benchmark
No rebasing means the savings you generate today compound over a decade — not reset against you.
#2
Enhanced prospective payments
Upfront, capitated cash flow enables independent practices and rural organizations to invest in care infrastructure without waiting on reconciliation.
#3
Access for small & rural practices
Lower alignment minimums, infrastructure support payments, and flexible risk tracks lower the barrier to entry for organizations of all sizes.
#4
Formal specialist integration
CMS-Administered Risk Arrangements (CARA) create a structured pathway to coordinate care with specialists — a major step beyond prior models.
#5
High-needs population support
All ACOs manage complex patients — with dedicated risk adjustment to ensure benchmarks reflect their true clinical complexity.
#6
Medicare-Medicaid integration pilot
A two-state pilot opens a new pathway for whole-person care for dual-eligible beneficiaries — the most complex population in the system.
Is your organization ready for LEAD?
With the RFA publishing in March 2026, now is the time to assess your patient population, model financial scenarios, and build the partnerships you'll need for Performance Year 1. We can help you evaluate readiness and navigate the application process
Key Milestones
