New ACO Model Signals Positive Impacts of A4H Advocacy. CMS indicated in its December Forecast for contractors plans to release a new ACO model through CMMI called the Long-Term Enhanced ACO Design, or LEAD Model. Per the forecast, LEAD will be a 10-year voluntary model intended to encourage ACO participation, with a reformed financial benchmarking approach and CMS-Administered Risk Arrangements for specialists. The original, intended announcement date for LEAD was listed as December 15.

Positive News. While more information and confirmation won’t come out until an official announcement, the brief description of LEAD is welcomed news and appears to include several elements A4H has been advocating for, including a future option for REACH participants, benchmarking for both high and low-spending ACOs, specialist engagement, and other flexibilities for ACOs to offer care management services to their populations. A4H looks forward to working with the Innovation Center on the future of value-based care and will continue to share additional details as they are made available.

ACCESS Model Favors Accountable Care Partnerships. A4H was pleased to see the new CMS Innovation Center ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model. The model is a 10-year voluntary demonstration designed to expand coverage of digital health services in traditional Medicare through new outcome-aligned payments for management of chronic conditions. Similar to other Innovation Center models, ACCESS will focus on patient outcomes and focus on better management of chronic diseases.

More to Come. The model intends to complement existing ACO models and new outcome-aligned payments won’t be included in ACO benchmarks and performance year spending until 2028. But the technology-supported tools ACCESS will incentivize could help accountable care providers better offer preventive services and manage chronic conditions. More information is expected in the request for applications later this month.

A4H’s Support. A4H was among the provider and patient societies that endorsed the model and also attended a launch event at HHS last week. A link to our statement is available here. CMMI will be hosting a call for A4H members on ACCESS on December 17th.

CJR Saved Medicare $112.7 Million. CMS released the latest annual report on the Comprehensive Care for Joint Replacement (CJR) Model covering performance years 6 and 7 (October 1, 2021 through December 31, 2023). Per the data, CJR saved Medicare $112.7 million over the period, which spanned 323 hospitals and more than 98,000 joint replacement episodes. Additionally, CMS reports CJR was not associated with any negative changes in the quality of care, measured through complication, mortality, and unplanned readmission rates as well as emergency room usage. The data shows safety-net hospitals were more likely to need to repay Medicare. CJR ran for eight performance years and ended in December 2024 after a three-year extension.

Accountability Matters. Once again, data shows that when you hold providers accountable for outcomes and costs, quality improves and spending lowers. A4H is proud to share these results as they further show that accountable care is superior to fee-for-service.

New MAHA Model Incentivizes Nutrition, Exercise. CMS introduced the MAHA ELEVATE Model, a new demonstration that will fund up to 30 evidence-based proposals focused on nutrition, physical activity, and other whole-person approaches to preventing and managing chronic disease. The model aims to build a stronger evidence base for interventions that support traditional Medicare and could inform future Medicare policy.

Importance. Accountable care has long been at the forefront of innovating to improve patient health, and MAHA ELEVATE creates additional opportunities to test and scale approaches that help improve patients’ health. Whole-person care, prevention, and better management of chronic conditions are foundational to accountable care, and A4H welcomes efforts that expand the tools available to clinicians and communities. A4H looks forward to engaging with members and partners as more details on MAHA ELEVATE emerge.

Competing Coverage Bills Fail in the Senate. The Senate failed to pass dueling health care bills this week. Two proposals – Senate Democrats’ bid to extend the Affordable Care Act enhanced premium subsidies for three years and a Republican counterproposal to fund Health Savings Accounts, Cost Sharing Reduction payments, and make additional reforms – both failed to reach the 60-vote threshold. Speaker Mike Johnson (R-LA) indicated that the House may consider health care legislation next week; however, no text has been released, so it remains unclear which proposals the House GOP will put forward.

It appears increasingly unlikely a broader health package will pass in the near term, but A4H continues to work with lawmakers to advance accountable care goals on Capitol Hill and advocate that accountability needs to be built into future payment reform efforts.

MedPAC Discusses Medicare Payment Approaches. At its public meeting on December 4 and 5, the Medicare Payment Advisory Committee (MedPAC) considered recommendations for its March 2026 Report to Congress. At one of the sessions, Commissioners reviewed and discussed how Medicare’s three payment systems – fee-for-service (FFS), Medicare Advantage (MA), and alternative payment models (APMs) – create different incentives that influence growth in spending. Commissioners considered streamlining and improving APM design and changes to MA risk adjustment, among other reforms, in effort to combat continued spending growth while maintaining beneficiary access to care.

Congressional Briefing on Kidney Care, Jan. 14. Join A4H, the Coalition to Transform Advanced Care, and the National Kidney Foundation for a Capitol Hill briefing on “Improving Kidney Care with Innovative Payment and Delivery Models.” This session will include conversations about CMMI and the Comprehensive Kidney Care Contracting model to improve health outcomes and lower costs. The briefing will be held at the Rayburn House Office Building, Room 2060 from 12pm to 1pm.

A4H Value Week In-Person Meeting, March 3. Join A4H members, friends, stakeholders, and policymakers for our 3rd annual in-person meeting at the Conrad Hotel in Washington, DC in conjunction with Health Care Value Week. We will bring together healthcare experts and key decision makers to discuss accountable care successes, and the work ahead in 2026.