CMS is planning a new model for 2027 that is expected to make participation with Accountable Care Organizations (ACOs) easier for fee-for-service providers.
The Long-term Enhanced ACO Design (LEAD) model will be a 10-year voluntary model that will focus on homebound or home-limited patients, as well as those dually eligible for Medicare and Medicaid.
“Through ACOs, health care providers will be empowered to deliver coordinated, accountable care and preventive services — keeping patients healthier and helping to reduce health care costs and unnecessary emergency room visits and hospitalizations,” according to CMS on the LEAD website.
The model will include “flexible, capitated population-based payments” that are expected to support “downstream value-based care arrangements,” according to CMS.
LEAD will include CMS Administered Risk Arrangements (CARA).
“The CARA initiative will provide robust CMS support to ACOs to enable episode-based risk arrangements between ACOs and their specialists and provider organizations to facilitate greater and stronger Preferred Provider relationships with these downstream health care providers,” CMS notes. “In addition, CARA will feature an episode-based falls prevention program.”
CARA will support ACO development of customized risk-sharing arrangements with Preferred Providers by:
- Sharing episode data with ACOs and the Preferred Providers with whom they enter into episode-based risk arrangements (EBRAs).
- Providing common contracting frameworks by enabling export of episode information into contracting templates.
- Allowing for configurable episode design.
- Making payment to ACOs and Preferred Providers based on their EBRAs.