CMS Announces Long-term Enhanced ACO Design (LEAD) Model: This voluntary 10-year accountable care model is slated to begin in 2027 and to last through 2036. LEAD will address barriers to ACO participation among rural, small, independent, and safety net providers and will include two voluntary risk-sharing options. The model also includes initiatives to align with the Trump Administration’s Make America Healthy Again (MAHA) priorities. A Request for Applications is expected in March 2026, and we await additional details, including the financial methodology.

Announcement Contains Wins for A4H Members. Importantly, LEAD addresses several A4H advocacy priorities, including ensuring that there is not a gap between the end of REACH and the next ACO model, providing participation options for high-needs ACOs, and additional benefit enhancements. A4H appreciates the certainty that LEAD provides for ACO REACH participants, another policy priority for us. Our statement of support is available here.

ACCESS Model: CMS released the request for applications for its new ACCESS Model, which was announced earlier this month. ACCESS attempts to provide a reimbursement pathway for novel digital health tools meant to provide better ways to manage chronic conditions. A4H also released a statement supporting ACCESS when it was announced.

More – But Not All Details. The RFA provides some details on payment mechanisms, requirements for participants, and beneficiary eligibility, but additional details are still needed to fully evaluate the opportunity.

CMS Releases Two Drug Pricing Models: CMS released the Global Benchmark for Efficient Drug Pricing (GLOBE) Model, which would set benchmarks for prices on Medicare Part B drugs based on prices in other comparable countries, and domestic manufacturers would pay rebates if their prices exceeded those benchmarks. CMS also released the Guarding U.S. Medicare Against Rising Drug Costs (GUARD) Model, which would test a similar framework except for Medicare Part D inflation rebate amounts are calculated for certain high-expenditure drugs. Both proposals are open for stakeholder comment.

Doctors Caucuses Request MACRA Modernization Feedback. The House GOP and Democratic Doctors Caucuses wrote to stakeholders regarding the Medicare Access and CHIP Reauthorization Act (MACRA) modernization, seeking input on necessary reforms to ensure future Innovation Center models facilitate cost and quality improvements, and how the Merit-Based Incentive Payment System (MIPS) can be reformed to reduce administrative burdens while promoting optimal outcomes.

APM Incentives in the Mix. With coverage taking much of the attention on Capitol Hill, A4H is pleased physician payments and incentives to participate in accountable care remain an action item for health policy-minded lawmakers. The Advanced APM bonus flat percentage-based bonus lapsed, and in its place, a favorable conversion factor update begins in 2026. MACRA reform could be a vehicle to strengthen APM incentives, making them more clear and immediate as well as updating CMMI’s framework to create more efficiency, and reducing burdens and waste associated with MIPS.

A4H has been following the bicameral interest in MACRA reform and has worked closely with the bipartisan Senate MACRA working group, which A4H responded to in 2024. Comments on the recent House request for input are due on January 16, and we will certainly be responding.

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.