ACO Models & MSSP

ACO strategy is increasingly shifting from MSSP-only optimization toward multi-payer, site-of-care-integrated risk models, with CMS’s LEAD model drawing attention because it builds on ACO REACH while creating clearer roles for in-home primary care, home health agencies, and potentially Medicare–Medicaid aligned risk arrangements. Provider coalitions including Premier and the Health Care Transformation Task Force are pressing CMS on the CY 2027 PFS/MSSP rule to expand accountable care participation while reducing administrative burden, improving interoperability, and preserving quality accountability—signaling that the next phase of MSSP policy will hinge on whether CMS can make risk-bearing participation operationally sustainable for physician groups and safety-net providers. For health systems, ACOs, and payers, the strategic question is moving from “whether to join an ACO” to how to build longitudinal care-management, home-based care, and Medicaid-capable infrastructure that can perform across MSSP, LEAD, TEAM, and state Medicaid ACO contracts (Premier comments; LEAD model analysis).