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The last two years have dramatically strengthened the ACO role in providing accountable care. New CMS specialty payment models—TEAM, ASM, and the proposed CJR-X—each include specific provisions for ACO coordination and referrals, extending the ACO’s reach deep into the specialty care continuum. LEAD, the new long-term ACO model with prospective payments, has redefined the future of the ACO as the hub of accountable care, with specialty integration built into its architecture. Quality reporting requirements have tightened. Data obligations have expanded. And beneath all of it, a fundamental question persists: is your organization actually built for what comes next?