A broader provider mix
Primary care, community health centers, rural clinics, specialists, and complex-care organizations can have defined roles.
The CMS LEAD Model
A longer horizon for better care.
Long-term Enhanced ACO Design is a voluntary, nationwide accountable care model for eligible Original Medicare beneficiaries. Beginning in 2027, it creates a 10-year path for prevention, coordination, patient empowerment, and sustainable clinical transformation.
January 1, 2027–December 31, 2036 · Original Medicare · National · Aged and Disabled, ESRD, and High Needs beneficiary categories
10 yearsA stable horizon without traditional rebasing
Broader accessDesigned to welcome more practice types
PreventionA required focus on healthier living
Patient choiceOriginal Medicare freedom remains intact
What LEAD is designed to change
More practices able to deliver accountable care well.
CMS designed LEAD to address barriers that have kept smaller, independent, rural, community health center, and specialized practices from participating in accountable care for the long term.
Prospective care investment
Population-based payment options are intended to support team-based care and care-delivery transformation.
High-needs integration
High-needs policy is integrated across ACOs so complex-care capability is not isolated in a separate track.
Specialist coordination
Preferred Provider and episode-based structures create pathways for closer primary and specialty collaboration.
Eligible populations
Not senior-only. Not high-needs-only.
LEAD applies to eligible people with Original Medicare and uses distinct categories to reflect different clinical and financial needs.
Aged and Disabled
The broad beneficiary category includes eligible people whose Medicare entitlement is based on age or disability and who are not otherwise classified as ESRD or High Needs for LEAD benchmarking.
End-Stage Renal Disease
ESRD is a distinct beneficiary category with its own clinical, risk-adjustment, and benchmarking considerations.
High Needs
CMS identifies High Needs status through defined mobility, frailty, risk, hospitalization, and qualifying skilled-nursing criteria, not through marketing labels or patient self-selection.
Dually eligible beneficiaries
LEAD includes a planned pathway for Medicare–Medicaid coordination in selected states. That component remains conditional on CMS's planning process, state selection, and partnership arrangements.
Eligibility and alignment
Built around established care relationships.
Eligible people generally have Medicare Parts A and B, have Medicare as their primary payer, live in the United States and the ACO service area, and are not enrolled in Medicare Advantage or another Medicare managed-care plan.
Care patterns can establish alignment.
CMS can align a person based on the plurality of qualifying care delivered through a participating practice.
People can identify their main source of care.
Voluntary alignment reinforces the person's active choice and the longitudinal clinician relationship.
Alignment is not a restricted network.
People keep the freedom to seek medically necessary care from any Medicare-enrolled provider.
What does not change
Accountable care does not replace Original Medicare, reduce covered benefits, or require a person to obtain all care from the ACO. It changes how participating clinicians and organizations coordinate and accept responsibility for quality and total cost of care.
Clinical quality
Quality should reflect health, continuity, and experience.
LEAD's quality strategy includes claims-based, patient-reported, and electronic clinical measures, with an explicit focus on prevention and sustained improvement.
Timely follow-up
Measure whether important acute events lead to appropriate clinical follow-through.
Days at home
Focus on helping people with complex chronic needs remain stable in the setting they prefer.
Chronic-condition control
Use blood-pressure and diabetes measures as part of a broader preventive-care strategy.
Patient experience
Listen to whether care is understandable, coordinated, respectful, and responsive.
Sphere's operating model
LEAD principles in clinical practice.
Sphere Health Partners aligns its value-based care approach with LEAD's goals and operating opportunities.
Clinical excellence first
Lead with prevention, evidence-based pathways, timely follow-through, and physician governance.
Access as part of the plan
Combine practice, home, virtual, transitional, specialty, and community pathways based on individual need.
Practices remain central
Add support around the existing relationship without duplicating care or displacing the clinician the patient trusts.
Data in service of action
Use authorized information to help teams identify needs, close loops, and account for the care delivered.
Sources: CMS LEAD overview, Request for Applications, and CMS FAQ.