CMMI LEAD and three key changes from ACO REACH: incorporating specialists, using AI-inferred risk, and simplifying tracks | Gabe Drapos (Pearl Health)

Gabe Drapos, Pearl Health COO and coauthor of the paper informing the LEAD Model, broke down LEAD, the successor to ACO REACH launching in 2027, framing it as a hybrid of REACH and MSSP. Three key changes: bringing specialists formally into total cost of care models for the first time; collapsing the standard and high-needs tracks so ACOs don't have to choose; and piloting AI-inferred risk adjustment, which would derive risk scores from utilization patterns rather than requiring providers to document HCC codes.

Kevin and Gabe explored how inferred risk could level the playing field for groups with historically weak documentation — and how success in LEAD could open the door to testing the same approach in MA broadly. Gabe also flagged that organizations will be making enrollment decisions with less information than usual given the compressed timeline (application deadline: May 17; lock-in by early September).

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