January 9, 2026  – The Centers for Medicare & Medicaid Services (CMS) has announced a new accountable care initiative aimed at expanding participation in value-based care while improving outcomes for patients with complex health needs. Known as the Long-term Enhanced Accountable Care Organization (ACO) Design, or LEAD, the model is intended to create more inclusive pathways for providers to participate in accountable care arrangements.

The LEAD model will be voluntary and is scheduled to operate from January 1, 2027, through December 31, 2036. CMS plans to open applications for participation in March 2026 through a formal request for applications. Agency officials say the long time horizon is meant to provide stability for organizations that want to invest in care coordination and long-term delivery reforms.

CMS designed LEAD to better support independent physician-led practices, rural providers, and organizations serving specialized or medically complex populations. Unlike some existing ACO models that can be difficult for smaller or nontraditional practices to enter, LEAD is structured to allow participation by organizations with prior ACO experience as well as those new to accountable care.

A key focus of the model is improving coordination between primary care physicians and specialists. CMS officials say LEAD is intended to give providers better tools and incentives to work together across care settings, particularly for patients with multiple chronic conditions or functional limitations. This includes individuals who are dually eligible for Medicare and Medicaid, as well as people who are homebound or home-limited.

To support these goals, the LEAD model will offer more refined risk adjustment and benchmarking methods aimed at accurately reflecting the needs of high-cost and high-need patients. CMS has said this approach is meant to reduce disincentives for providers that care for more medically complex populations.

Participating ACOs will be able to choose between two voluntary risk-sharing tracks. Under the global risk option, organizations may earn up to 100% of savings compared to their benchmark, but will also be responsible for up to 100% of losses. The professional risk option offers a lower level of exposure, allowing ACOs to share up to 50% of savings and losses relative to their established benchmarks. CMS says this flexibility is intended to accommodate organizations with varying levels of readiness for financial risk.

Another notable component of LEAD is its emphasis on Medicare and Medicaid integration. CMS plans to use the model to test new incentives that encourage providers and health care organizations to coordinate care across the two programs, particularly for dually eligible beneficiaries who often experience fragmented services.

CMS officials say the LEAD model reflects a broader effort to make accountable care more accessible while addressing long-standing gaps in care coordination for complex and underserved populations. If successful, the model could play a significant role in shaping the next phase of value-based care across Medicare and Medicaid.