The Centers for Medicare & Medicaid Services’ (CMS) Long-term Enhanced Accountable Care Organization (ACO) Design (LEAD) model presents a significant opportunity to improve care coordination, financial alignment, and outcomes for individuals dually eligible for Medicare and Medicaid. This paper summarizes key themes and strategic considerations from Milliman’s analysis of the LEAD model, highlighting potential implications for states, providers, ACOs, and Medicaid managed care organizations (MCOs).
Highlights
- The LEAD model is designed to better integrate Medicare and Medicaid services for dual eligible beneficiaries while promoting value-based care and long-term cost management.
- CMS intends to pilot the model in two states — one primarily fee-for-service Medicaid state and one managed care state — creating opportunities for innovative partnerships between ACOs, providers, states, and Medicaid MCOs.
- Key proposed model features include upfront capitation payments, refined risk adjustment, incentives for provider collaboration, benchmark stability over a 10-year period, and enhanced support for rural providers.
- The paper explores strategic considerations for participating stakeholders, including care coordination approaches, financial risk-sharing methodologies, and the interaction between LEAD and existing integrated dual eligible programs.
- Organizations considering participation are encouraged to assess readiness, identify potential partners, and evaluate operational and financial implications ahead of the application process.
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