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On March 31st, 2026, CMS released details on a new model called LEAD — the Long-term Enhanced ACO Design. It’s positioned as a replacement for ACO REACH. However, LEAD is not just an evolution of ACO REACH. It’s a fundamentally different proposition: a ten-year model with a fixed benchmark that never rebases, an integrated approach to high-needs populations, a ramp designed to bring in organizations that have never participated in value-based care, and a plan to eventually replace traditional risk adjustment with artificial intelligence.
This article explains what the model is, why it is structured the way it is, and why CMS designed it to attract providers who have historically stayed on the sidelines.
The Pitch: Ten Years, No Rebasing
The single most important design feature of LEAD is its benchmark structure. Benchmarks in MSSP get recalculated every agreement period. Organizations that do a good job of managing costs receive a lower benchmark (higher performance threshold) the next time around. ACOs have complained about this for years because it creates a dynamic where success is punished and savings today become targets tomorrow.
LEAD eliminates this entirely. The benchmark baseline is set using three calendar years of spending data (CY2024, CY2025, and CY2026), and that baseline is fixed for the entire ten-year model. It’s trended forward each year using a blend of national growth rates, regional growth rates, and the Accountable Care Prospective Trend (ACPT), which is an upfront projected growth factor, not an observed national or regional trend. However, the underlying historical spending is never recalculated.