LEADing with capitation: Can CMS save primary care with predictable payments per patient?

Beginning Jan. 1, 2027, the Centers for Medicare & Medicaid Services (CMS) will launch the Long-term Enhanced ACO Design (LEAD) Model, a 10-year accountable care organization (ACO) initiative that succeeds ACO REACH. Unlike earlier ACO models, LEAD is built to draw in a broader range of practices, including smaller, independent and rural physician groups that have historically avoided ACOs because of financial and administrative barriers. Central to that effort is capitation: predictable, per-patient payments that replace the volume-driven economics of fee-for-service.

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