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Editor’s note: This is the third article in a series about CMS’ new LEAD model. Article one explored the new model in broad strokes. Article two discussed AI-Inferred Risk Adjustment. Future posts will explore CMS-administered risk arrangements and beneficiary enhancements.
LEAD, CMS’ ten-year bet on accountable care, replaces ACO REACH, a model planned to sunset on December 31, 2026. Participants will need to decide their path forward, which includes whether to enroll in MSSP or convert to LEAD. A deciding factor will be whether the math works, and benchmarking will be critical in answering that question.
LEAD does not treat all Medicare beneficiaries the same way for benchmarking purposes. It splits them into three populations: 1) aged and disabled (A&D); 2) end-stage renal disease (ESRD); 3) a new category called High Needs. Each population segment will have its own specific benchmark.
The model’s design then applies a set of ACO-specific adjustments that are intended to reward efficient organizations, give high-spending organizations a realistic on-ramp, and recognize historical savings. These adjustments differ depending on your history with shared savings models, and those organizations coming from MSSP may be at a structural disadvantage compared to organizations coming from REACH or newly entering into CMS value-based care programs.