ACO programs: MSSP, ACO REACH and LEAD
ACO performance is practice workflow, measured at scale
Benchmarks, quality scores and shared savings are decided by what happens in each participant practice. We help ACOs and their practices get ready for the Medicare Shared Savings Program and the transition from ACO REACH to the LEAD Model, then run the workflows that move quality and cost.
- MSSP BASIC and ENHANCED
- APP Plus and eCQMs
- ACO REACH ends Dec 31, 2026
- LEAD Model PY2027–PY2036
Who it's for
Built for the teams that run this program
MSSP ACOs
ACOs in the BASIC or ENHANCED track that need eCQM reporting across many EHRs and practices that are generating savings rather than consuming them.
ACO REACH organizations
REACH ACOs facing the end of the model on December 31, 2026, whether moving to LEAD, to MSSP or planning for a later LEAD window.
Practices joining or evaluating an ACO
Independent practices deciding whether to join, which ACO or track fits, and what participation will ask of their staff.
Clinically integrated networks
Networks holding Medicare ACO and Medicare Advantage value-based contracts that want one quality and documentation standard across both.
Design & launch
How we design and launch it
Readiness first, then the practice-level work that a benchmark rewards.
- 1
Readiness assessment
Attributed lives, cost and utilization patterns, quality reporting capability and which program, track or ACO partner fits.
- 2
Participant TIN review
Roster accuracy, whole-TIN participation, overlap between programs and the practice-level data each TIN can supply.
- 3
Quality reporting build
eCQM readiness audit across participant EHRs, structured data capture fixed at the source and a practice-level APP Plus tracker.
- 4
Care model workflows
Transitional care, chronic care management, AWVs and follow-up after acute exacerbations, built into each practice's routine.
Gate: Pilot in the practices with the most room to improve.
- 5
Performance reporting
Monthly practice-level reporting on spend, utilization and quality, so drift is caught in the quarter it happens.
- 6
Beneficiary engagement
Annual visit outreach, voluntary alignment education where allowed, and the benefit enhancements your program offers.
Operations
How the program runs day to day
The programs in brief
Medicare Shared Savings Program
Ongoing
- BASIC track: a glide path from one-sided to two-sided risk
- ENHANCED track: the highest level of risk and reward
- Quality reported through the APP Plus measure set, using eCQM, MIPS CQM or Medicare CQM collection types
- Benchmarks built from historical spending, with regional and prior-savings adjustments
ACO REACH
Ends December 31, 2026
- CMS Innovation Center model ending after performance year 2026
- Its successor for many participants is the LEAD Model
- Benefit enhancements and quality measures largely carry into LEAD
LEAD Model
PY2027 through PY2036
- Ten-year CMS Innovation Center ACO model announced December 18, 2025
- Global (full risk) and Professional (shared risk) options
- A benchmark built once from a fixed baseline and not rebased during the model
- A quality withhold earned back on performance
Benchmark and quality concepts we work on
Benchmarks
A spending target per beneficiary. Savings are measured against it, so the practice-level drivers matter: avoidable admissions, post-acute use, ED visits and accurate documentation of patient complexity.
Quality withhold
In LEAD, a portion of the benchmark is withheld and earned back based on quality performance. In MSSP, the quality score determines eligibility for, and the share of, savings.
Risk adjustment
Both programs adjust for patient complexity with growth caps, so accurate documentation helps and aggressive coding does not raise the benchmark beyond the cap.
Claims-based quality measures
Readmissions, unplanned admissions for patients with multiple chronic conditions, and timely follow-up after acute exacerbations respond to transitional care and chronic care workflows.
Documentation & compliance
Documentation and compliance essentials
Dates and design details as described in our CY 2027 FAQ, current as of September 9, 2026, with LEAD dates updated October 2026.
LEAD and REACH: key dates
May 17, 2026
- What happens
- LEAD applications closed.
September 11, 2026
- What happens
- Deadline to resolve TIN overlap between MSSP and LEAD rosters; a TIN cannot sit in both.
Sept 15 – Dec 31, 2026
- What happens
- Optional LEAD implementation period: ACOs can begin voluntary alignment, with no payment or risk.
September 21, 2026
- What happens
- CMS published a list of 79 LEAD Implementation Period ACOs.
December 31, 2026
- What happens
- ACO REACH ends.
January 1, 2027
- What happens
- LEAD performance year 2027 begins. CMS anticipates later application windows but has not announced dates.
LEAD design points to plan around
- Global option: 100% of savings and losses. Professional option: a share of savings and losses, with no discount.
- Fixed three-year baseline (2024 to 2026 for PY2027), not rebased through 2036.
- A 3% quality withhold earned back on performance; no minimum savings or loss rate.
- Quality: five measures carried from REACH (including readmissions, unplanned admissions, days at home, timely follow-up and CAHPS) plus two MSSP eCQMs phased in from optional to pay-for-performance.
- Prospective, claims-based alignment on the plurality of primary care services, with voluntary alignment taking precedence.
- Whole-TIN participation and minimum aligned-beneficiary thresholds.
MSSP changes proposed for 2027
From the CY 2027 Physician Fee Schedule proposed rule (July 2026). Proposals, not final.
- One-sided risk in BASIC capped at five years for agreements starting in 2027.
- APP Plus trimmed to eight quality measures.
- Prepaid shared savings discontinued after the 2027 cohort.
- Part B cost-sharing support for beneficiaries allowed from April 2027.
- Primary care billed under non-ACO TINs excluded from assignment starting 2028.
KPIs we track
What we measure with you
Spend per beneficiary vs. benchmark
By practice, trended monthly.
Admissions and readmissions
Per 1,000 beneficiaries, and readmissions within 30 days.
ED visits per 1,000
With avoidable visits flagged for follow-up.
eCQM performance and completeness
APP Plus measures by participant TIN and EHR.
AWV and TCM completion
Annual visits and transitional care delivered on time.
Documentation accuracy
Chronic conditions assessed and documented each year, from audit.
Baselines and targets are set from your own data at the start of an engagement. We do not promise specific results.
FAQs
Common questions
We were not selected for LEAD, or did not apply. What now?
We build an MSSP transition plan and a readiness roadmap for a future LEAD window, so the next application is a decision rather than a scramble.
Can a TIN participate in both MSSP and LEAD?
No. CMS required overlap between MSSP and LEAD rosters to be resolved by September 11, 2026.
Do you model our shared savings?
We can model scenarios using your own baseline data, clearly labeled as estimates. We do not promise savings results.
Related services
Programs that work alongside this one
ACO & Value-Based Performance Enablement
Tie quality, risk and utilization work to Stars, withholds and shared savings.
Learn moreMIPS & Quality Payment Program
Measure selection, data completeness and submission readiness.
Learn moreTransitional Care Management (TCM)
Two-business-day contact and 7/14-day face-to-face after discharge.
Learn moreRisk Adjustment & Coding Optimization
CMS-HCC V28 risk capture: prospective review, retrospective audits and provider education.
Learn more
Ready to simplify the complex?
Book a consultation.
A working conversation about your patients, payers, EHR and staffing, and whether this program fits. Please do not send patient information.