ACO REACH Model

Key facts

Run by

CMS Innovation Center, under Section 1115A of the Social Security Act

Performance years

January 1, 2023 through December 31, 2026

Predecessor

Global and Professional Direct Contracting (GPDC) Model, 2021 to 2022

Risk options

Professional (50 percent shared risk) and Global (100 percent shared risk)

Announced successor

LEAD Model, scheduled for January 1, 2027 through December 31, 2036

What is the ACO REACH Model?

ACO REACH is a CMS Innovation Center model that tests whether accountable care organizations taking substantial financial risk, often with capitated payments, can lower Medicare spending while maintaining quality. It is a redesign of the Global and Professional Direct Contracting (GPDC) Model, which ran for performance years 2021 and 2022.

Like other Innovation Center models, ACO REACH has a fixed end date. Its four performance years run from 2023 through 2026, and CMS stated it would not accept new applications for the remaining model duration. CMS has announced the Long-term Enhanced ACO Design (LEAD) Model as its successor, beginning January 1, 2027.

How ACO REACH is structured

The model combines two risk-sharing options with three ACO types:

• Professional option: the ACO shares 50 percent of savings or losses and receives Primary Care Capitation payments.
• Global option: the ACO takes 100 percent of savings or losses and chooses Primary Care Capitation or Total Care Capitation.
• Standard ACOs: organizations with experience serving Original Medicare beneficiaries.
• New Entrant ACOs: organizations that have not traditionally served an Original Medicare population.
• High Needs Population ACOs: organizations serving beneficiaries with complex needs, including many people dually eligible for Medicare and Medicaid.

Why ACO REACH matters

ACO REACH has been the main Medicare vehicle for full-risk, capitated arrangements in Original Medicare, attracting primary care groups, physician enablement companies and organizations focused on high-needs patients. Because capitation replaces some or all fee-for-service payments to participating providers, these ACOs manage total cost of care more directly than most Shared Savings Program ACOs.

The transition matters as much as the model. Participating organizations must decide whether to move to LEAD, the Shared Savings Program or Medicare Advantage contracting, and those choices will reshape which groups hold risk for Original Medicare patients after 2026.

Limitations of ACO REACH data

Participant lists and results change every performance year as ACOs join, merge or exit, so any list should be dated. CMS adjusted the financial methodology for performance year 2026, which complicates comparisons across years. Details of the LEAD Model, including who participates, can change before it begins.