ACO REACH Is Ending: What the LEAD Model Means for 2027

The LEAD Model is CMS's successor to ACO REACH. REACH ends December 31, 2026. LEAD runs January 1, 2027 through December 31, 2036. ACOs choose Global Risk (up to 100% of savings and losses) or Professional Risk (up to 50%). LEAD promises a 10-year benchmark path with no rebasing, and it targets small, rural and independent practices.

The timeline

What LEAD is

LEAD is a voluntary accountable care model from the CMS Innovation Center. An accountable care organization (ACO) is a group of providers. It takes responsibility for the total cost and quality of care for a set of Medicare patients. If spending comes in under a benchmark, the ACO shares the savings. If it comes in over, a risk-bearing ACO pays back part of the loss. See our LEAD Model glossary entry for a short definition.

Here's what CMS says LEAD includes.

Two risk tracks.

• Global Risk: the ACO receives and is liable for up to 100% of savings and losses.
• Professional Risk: savings and losses are capped at 50%.

Capitated, population-based payments. Capitation means a fixed monthly payment per patient instead of fee-for-service claims. See our capitation glossary entry.

No rebasing. CMS describes "a 10-year pathway toward sustainable benchmarks" with "a predictable window without rebasing." Rebasing is when CMS resets your spending target using your recent performance. In many models, ACOs that save money see their targets drop and their future savings shrink. LEAD is designed to avoid that during the term.

CARA. CMS-Administered Risk Arrangements are optional episode-based deals between an ACO and its specialists. They include a falls-prevention episode.

Beneficiary incentives. LEAD includes "Part B cost sharing support and by 2029, a Part D premium buy down." Both are meant to encourage patients to use ACO providers.

Medicaid integration planning. CMS plans Medicaid-integration work from March 2026 through December 2027.

Who LEAD targets

CMS names "smaller, independent or rural-based practices," federally qualified health centers (FQHCs) and rural health clinics. CMS says it wants to bring more of these groups into ACOs. CMS also lists current ACO REACH participants as expected applicants.

CMS emphasizes high-needs patients too. That includes people dually eligible for Medicare and Medicaid and people who are homebound.

One structural change matters for operations. Per Bass Berry's summary of the RFA, every provider billing under a participating TIN is automatically included in the ACO's alignment, capitation and quality reporting. A TIN is the tax ID the group bills under. Plan for the whole TIN, not a hand-picked roster.

What changes day to day under LEAD

For practice staff, three parts of the design show up in daily work.

Cash flow. Capitation shifts revenue from per-visit claims toward fixed per-patient payments. Finance teams should model the 2027 cash cycle before January, not after.

Patient cost questions. Part B cost-sharing support means some patients may owe less for certain services. Expect questions at check-in. Give front desk and billing staff one approved answer to use.

Whole-TIN reporting. If every clinician under the TIN is in, every clinician's documentation and gap closure counts. A specialist or part-time provider who never thought about ACO quality is now part of it. Tell them before the year starts.

If you didn't get into LEAD: MSSP in 2026

The Medicare Shared Savings Program (MSSP) is the permanent ACO program. It's the main alternative for REACH ACOs not moving to LEAD. Read our MSSP glossary entry for background. The 2026 fee schedule changed it in three ways.

One-sided risk is capped. One-sided means you share savings but not losses. For agreements starting on or after January 1, 2027, one-sided time in the BASIC track is capped at 5 years. It's limited to an ACO's first agreement period.

Smaller ACOs can enter. An ACO can now enter with fewer than 5,000 assigned beneficiaries in benchmark year 1 and/or 2. That's only allowed in the BASIC track.

The health equity adjustment is gone. CMS removed it from quality scoring starting in performance year 2026.

What REACH ACOs should do with attributed patients now

Your REACH patients don't disappear on January 1. They still need visits, care management and gap closure. Your 2026 performance year still counts. Here's what to do in Q4.

Step 3 is where most ACOs fall short. The list exists in your attribution file. The work is reaching every patient on it. Rivvi's free workspace lets you upload the attribution file and claims export and ask which patients have no visit this year. On the Team plan, Rivvi calls or texts those patients. It warm-transfers them to your scheduler or creates a follow-up task, and logs every outcome. See how Rivvi supports value-based care teams, or read our guide to building a care gap list from an attribution file.

Sources

• CMS Innovation Center: LEAD Model
• ATI Advisory: CMS Announces the LEAD Model
• Bass Berry: CMS LEAD Model Request for Applications Released
• Federal Register: CY2026 Physician Fee Schedule Final Rule (Nov 5, 2025)
• MDinteractive: CMS Finalizes 2026 Updates to the Medicare Shared Savings Program