The new ACO Long-Term Enhanced Design (LEAD) model aims to improve care for people enrolled in both Medicare and Medicaid by creating greater financial accountability across the two programs. However, designing integrated risk contracts will require policymakers to address differences in spending, incentives, and care delivery between Medicare and Medicaid.
CHIBE experts Eric T. Roberts, PhD, and Rachel M. Werner, MD, PhD, and their co-authors identify four priorities for the model: developing appropriate Medicaid spending benchmarks, improving risk adjustment, calculating shared savings and losses across both programs, and ensuring access to interoperable data. These elements will be essential for supporting coordinated care while limiting cost shifting between Medicare and Medicaid.