author: real-time medical system
CMS has set a new direction for accountable care. The Long Term Enhanced ACO Design (LEAD) model, which replaces ACO REACH ending at the end of 2026, runs from January 1, 2027 to December 31, 2036. This is a full 10-year effort, making it the longest accountable care program ever tested by CMS.
For acute care health systems and ACO leaders, LEAD not only extends timelines, but fundamentally reshapes how value-based care (VBC) success is achieved and sustained over time.
While previous models focused on short-term savings and temporary performance, LEAD requires a sustained, population-wide approach to care delivery and cost control. Acute care providers will be held accountable for the total cost of care and quality of care attributable to Medicare beneficiaries for 10 years, raising the bar for how effectively they can manage ongoing risk. This shift elevates care coordination from an operational priority to a long-term strategic capability, especially in post-acute care (PAC) where risks, costs, and variability are concentrated.
Achieving that level of performance under LEAD will increasingly rely on organizations’ ability to maintain visibility and influence beyond hospital discharge, leveraging timely data to guide interventions, manage utilization, and drive better outcomes based on long-term value.
And this reality extends far beyond the hospital stay. It all depends on how effectively an organization manages patients across the continuum. – Especially in the post-acute setting, where visibility has historically been limited.
Phyllis Wojtusik, RN, VP of Value-Based Care, Real Time
“In the previous MSSP and ACO models, patients were navigated through a three-year outcome period. With the LEAD model, the view is changing to a 10-year attribution period. As patients get older, they have much greater exposure to post-acute and long-term SNF care. This requires strategically incorporating data from these levels of care to drive overall outcomes.” – This includes readmissions as well as long-term care and chronic disease management hospitalizations. ”
What LEAD looks for in participating providers
LEAD poses two-sided risk with future population-based payments – This means that the emergency provider shares in the savings, but is also responsible for any excess costs. This model focuses on medically complex Medicare beneficiaries with high needs, including those with multiple chronic conditions, functional limitations, high hepatocellular carcinoma risk scores, and dual eligibility.
For this population, PAC is not peripheral – It is central to both cost control and quality outcomes.
Several core components of the LEAD model make post-acute performance more important.
- SNF 3-day rule exemption: It eliminates traditional hospitalization requirements, expands access to PAC, and increases the complexity of utilization.
- Stable benchmarks: Deliver long-term ROI from data, analytics, and care infrastructure capabilities
- Growing expectations for care coordination: Requires continuous follow-up, early intervention, and closer coordination across healthcare settings
Capabilities once considered advanced, such as real-time patient tracking, managing the transition from short-term to long-term residents, and early identification of increasing risks, are now fundamental to VBC success under LEAD.
Anthony Reid, Vice President of Strategic Partnerships, Real Time:
“To be successful with LEAD, acute care providers and health systems must move from a temporary mindset to long-term population ownership. That requires intentional investments in post-acute partnerships, real-time data, and care coordination capabilities that can scale over a full decade.”
Post-acute blind spots that jeopardize value-based outcomes
Despite the growing importance of PAC in improving outcomes and costs, it remains one of the most visible parts of most acute care organizations, creating a critical gap in value-based performance management.
When a patient is discharged to a skilled nursing facility or another care facility, visibility often decreases, instead relying on claims data that can be delayed by weeks or even months. For shorter duration episodic models, that delay is manageable. After a 10-year commitment period, risks to both financial and clinical performance increase.
The scale of the challenge is important.
These represent not only system inefficiencies but also missed opportunities to intervene and improve VBC outcomes.
Without real-time visibility into what’s happening after discharge, care teams can’t detect worsening symptoms early or intervene before complications occur. This becomes even more important as risk profiles and cost trajectories change significantly as patients move from short-term rehabilitation to long-term care.
Phyllis Wojtusik, RN:
“If care teams don’t understand what’s happening to their post-acute and long-term care populations, they can’t influence it. This lack of knowledge will only grow over time and can have a dramatic impact on patient quality (admissions, readmissions, post-acute length of stay) and economic outcomes. With the aging of the LEAD population, this could have devastating effects for ACOs.”
How real-time data enhances proactive, long-term population health management
Success under LEAD will require closing the post-acute visibility gap, which will require more than retrospective data.
Real Time Medical Systems’ (real-time) interventional analytics solutions directly address this challenge and provide continuous live clinical insights across the post-acute continuum. By integrating directly with the SNF EHR, the platform captures both structured and unstructured data and applies AI-driven analytics to identify subtle changes in patient conditions as they occur.
When a risk is detected, care teams receive instant alerts and recommendations for evidence-based interventions. This allows you to take action before conditions worsen and prevent avoidable exploitation that undermines value-based performance.
This supports a fundamental change in the way emergency care providers manage populations.
- From reactive to proactive: Intervention before it gets worse can lead to hospitalization.
- From episode to continuation: Maintain visibility throughout the patient treatment process
- From silos to collaboration: Adjust providers across settings with shared insights
Building effective care coordination under LEAD also requires consistent two-way communication between acute and post-acute partners. By sharing and visualizing patient status and progress, providers can enable smoother transitions, identify readiness for discharge sooner, and ensure patients are placed in the most appropriate care environment, improving both outcomes and cost efficiency over time.
The platform also allows providers to strengthen post-acute partnerships by providing objective, real-time performance insights, allowing organizations to identify high-performing SNFs, reduce variability, and build a tailored network that consistently delivers VBC outcomes.
The impact of Real Time’s solutions and approaches is measurable and grows over time with 10-year models like LEAD.
- to 50% reduction in readmissions (average)improve both cost and quality performance
- to 40% reduction in post-acute hospital stayhelps optimize utilization and total cost of care
Anthony Reid:
“With a 10-year model like LEAD, small gaps in visibility become significant performance challenges over time. A real-time platform provides organizations with the continuous clinical insight they need to stay ahead of risk and manage their populations with confidence.”
The long game begins now
LEAD begins on January 1, 2027, and preparations are already underway.
This model represents a structural shift from temporary outcomes to ongoing accountability for outcomes based on population health and values. Successful organizations are those that invest early in a connected, data-driven approach. The approach extends beyond the hospital to the post-acute setting, where outcomes and costs are highly impactful.
Real-time post-acute visualization is the cornerstone of that strategy. By providing actionable clinical insights for medical teams, enabling early intervention, and supporting more informed network decision-making, Real Time helps emergency care providers manage risk across the care delivery continuum and drive stronger long-term VBC performance as they navigate the next decade under LEAD.
For more information, please visit: www.realtimemed.com.
