CMS Unveils LEAD Model to Expand Home-Based Care for Vulnerable Patients
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A new initiative from the Centers for Medicare and Medicaid Services (CMS) aims to bolster accountable care organizations (ACOs) focused on serving patients who are homebound and dually eligible for Medicare and Medicaid.
The 10-year voluntary program, officially named the Long-term Enhanced ACO Design (LEAD) Model, is slated to begin after the current ACO Realizing Equity, Access, and Community Health (REACH) program concludes on Dec. 31, 2026. The LEAD model is expected to foster new and strengthened partnerships between ACOs and home-based care providers.
According to industry experts, the LEAD model represents a natural progression from the existing ACO REACH program. “In this go around, there seems to be more focus on folks that are homebound and have difficulty leaving the home, trying to reach more of those high-severity patients,” a senior official stated. “So we’re super optimistic about that, because that’s definitely the type of patients we care for in the home setting.”
Expanding Access to Care in Underserved Communities
The CMS initiative specifically targets an increase in the participation of small, rural, and independent health care providers, as well as Community Health Centers, within the ACO framework. This expansion is coupled with a renewed emphasis on preventive care, allowing providers greater flexibility to regularly check in with patients and coordinate care between scheduled visits.
The program will utilize capitated, population-based payments, designed to support team-based care and facilitate value-based care arrangements further down the line. This payment structure aims to incentivize providers to focus on proactive, holistic patient management.
Optimism Tempered with Caution
While the National Alliance for Care at Home (the Alliance) has expressed optimism regarding the LEAD model, concerns remain about the specifics of its implementation. “The devil is in the details,” one analyst noted. “We’re just going to keep our eye out for when CMS releases the request for applications, just to see if we can get more information.”
However, the Alliance is encouraged by the program’s targeted approach. “At the same time, [we are] pretty excited, because they don’t often target their models towards our patient population specifically,” the analyst continued. “There are a lot of models that touch on our space, but this one, it seemed, was very much focused on our patient population. Super pleased to see that there’s some attention given to our high needs patient populations.”
A Familiar Opportunity for Home-Based Care
The LEAD model will present a similar opportunity for home-based care providers as the current ACO REACH program, both of which place responsibility for the total cost of care on the ACO.
“Where our providers come in as they’re going to be partnering with ACOs and hopefully helping patients stay in their preferred location, which is in the home,” a representative from the Alliance explained. “We think it’s a pretty good opportunity to establish new partnerships that might not be there with ACOs and other provider types, or just strengthen existing ones that we already have.” This collaborative approach is expected to improve patient outcomes and reduce healthcare costs by delivering care in the comfort and familiarity of patients’ homes.
