Understanding the Model
What is LEAD?
The Long-term Enhanced ACO Design is CMS's next-generation accountable care model -- a decade-long commitment to value-based care that replaces ACO REACH starting January 1, 2027.
The Evolution of Medicare ACOs
The Pathways team has been involved in Medicare value-based care since the very beginning.
Pioneer ACO Model
CMS's first advanced ACO model for organizations with experience in coordinated care. 32 Pioneer ACOs launched the accountable care movement.
MSSP Established
The Medicare Shared Savings Program launched as the permanent ACO track under the ACA. Still operating today with 450+ ACOs.
Next Generation ACO
Higher risk, higher reward model for experienced ACOs willing to take on population-based payments.
Direct Contracting
CMS's first capitated primary care model. Global and professional risk options with prospective payments.
ACO REACH
Refined model with health equity focus. 74 ACOs participating in the final year (2026).
LEAD Model Launches
10-year model. No rebasing. Designed for independent practices. The most ambitious ACO program CMS has ever created.
Key Features
What Makes LEAD Different
Decade-Long Stability
Running from 2027 through 2036, LEAD is the longest Innovation Center ACO model ever. Invest in care transformation knowing the rules won't change on you.
No Benchmark Rebasing
Unlike MSSP, your benchmark doesn't reset when you improve. Early adopters lock in favorable benchmarks and keep the savings they create.
Prospective Payments
Receive population-based, capitated payments upfront -- not after the fact. Predictable cash flow to invest in the care your patients need.
TIN-Level Participation
All primary care providers under a participating TIN are included. Simplified participation -- no individual NPI opt-in headaches.
CARA Specialist Program
New CMS-administered episode-based payments for specialists. Engage your referral network in value-based care with minimal admin burden.
Patient Benefits
Part B cost-sharing support, Part D premium buydowns (2029), expanded nutrition therapy, and chronic disease prevention rewards for your patients.
Model Comparison
LEAD vs. MSSP vs. ACO REACH
Understanding where LEAD fits in the Medicare ACO landscape.
| Feature | MSSP | ACO REACH | LEAD |
|---|---|---|---|
| Duration | 5 years | 4 years | 10 years |
| Benchmark Rebasing | Yes (penalizes improvement) | Annual | No rebasing |
| Payment Model | Retrospective FFS | Prospective capitation | Prospective capitation |
| Risk Tracks | One-sided / Two-sided | Global / Professional | Global / Professional |
| Participation | TIN-level | TIN + NPI opt-in | TIN-level |
| Specialist Integration | Limited | Preferred provider | CARA (episode-based) |
| Rural Support | Standard | Standard | Add-on payments + lower minimums |
| Patient Benefits | Limited | Limited | Cost-sharing, Rx buydown, nutrition |
Timeline
The Road to PY 2027
Pathways' RFA application is just the first step. Practices have throughout 2026 to join Pathways' Participant TIN List or Preferred Provider List before the Performance Year begins.
Spring 2026
RFA Released
CMS opens the LEAD application portal
Summer 2026
Pathways Applies
Abbreviated application as a Renewing ACO
Fall 2026
Practices Onboarded
Implementation Period -- voluntary alignment, Participant TIN and Preferred Provider contracting
Late 2026
Lists Submitted
Participant TIN and Preferred Provider Lists locked in with CMS
January 2027
PY 2027 Begins
First performance year of the 10-year model