Is This The Right ACO For Your Practice?
Learn About The New LEAD Model
CMS’ new ACO model, LEAD, stands for Long-term Enhanced ACO Design, and it’s scheduled to start in January of 2027. However, at Genuine Health Group, we are already actively recruiting physicians to join our new LEAD ACO.
The Best Of REACH And MSSP
The new LEAD ACO model borrows from the long-established Medicare Shared Savings Program, which rewards physicians when their total cost of care comes in below established benchmarks, allowing them to share in the savings achieved. Like all ACOs, the goal is to keep your patients as healthy as possible to prevent unnecessary hospitalizations and other avoidable, costly interventions. The more you save compared to the benchmark while keeping your patients healthy and satisfied the more you benefit financially.
The new LEAD program also incorporates elements from the REACH program that it replaces. Most notably, practices will have the option to take on greater accountability for cost and outcomes in exchange for the opportunity to earn a larger share of savings – reflecting the REACH model’s principle of increased upside with higher levels of risk.
Casting A Wider Net
The new LEAD model also seeks to attract physician practices that are new to ACOs, as well as practices with large populations of high-needs patients. For these practices, it will pay higher reimbursements adjusted for their patients’ complex health conditions.
Among other changes, the LEAD program will designate ACO participants at the practice level, rather than by individual NPIs. This is particularly helpful for practices that have providers joining (or leaving) during the plan year.
5 Advantages Of The New LEAD ACO Model
With a longer program duration of 10 years and added flexibility, the LEAD model gives practices more advantages than ever, including:
1.
Greater opportunity for achieving shared savings, whether you are new to ACOs or have years of experience with advanced payment models.
2.
Greater financial stability and better forecasting, thanks to a longer program duration that won’t recalculate financial benchmarks (which used to make it harder to achieve savings).
3.
Greater emphasis on forging partnerships with high-performing specialists to deliver patients a true “preferred provider” option.
4.
Greater support for complex patients, including high-needs patients and those who are dual eligible for Medicare and Medicaid.
5.
Greater opportunity for coordinated, proactive, preventive care through tools that encourage patients to seek care from high-value providers.