Written by: Real Time Medical Systems
CMS has set a new direction for accountable care. The Long-term Enhanced ACO Design (LEAD) model, which will replace ACO REACH when it concludes at the end of 2026, spans January 1, 2027 through December 31, 2036 – a full decade of commitment that represents the longest accountable care program CMS has ever tested.
For acute care health systems and ACO leaders, LEAD doesn’t just extend the timeline – it fundamentally reshapes how value-based care (VBC) success must be achieved and maintained over time.
Where previous models emphasized short-term savings and episodic performance, LEAD requires a sustained, population-wide approach to care delivery and cost management. Acute providers will be accountable for the total cost and quality of care for attributed Medicare beneficiaries over 10 years – raising the bar for how effectively they manage risk across the continuum. That shift elevates care coordination from an operational priority to a long-term strategic capability – especially in post-acute care (PAC), where risk, cost, and variability are concentrated.
Achieving that level of performance under LEAD will increasingly depend on an organization’s ability to maintain visibility and influence beyond discharge – leveraging timely data to guide interventions, manage utilization, and drive better long-term value-based outcomes.
And this reality extends well beyond the hospital stay. It will hinge on how effectively organizations manage patients across the full continuum – particularly in post-acute settings where visibility has historically been limited.
Phyllis Wojtusik, RN, EVP of Value-Based Care, Real Time
“In previous MSSP and ACO models, patients were navigated through a three-year period for outcomes. With the LEAD model, the view is changing to a ten-year attributed period. As patients age, the exposure to post-acute and long-term SNF care is much greater. This requires a strategic incorporation of data from these levels of care to drive overall outcomes – not only in readmissions but admissions from long-term care and chronic disease management.”
What LEAD demands from participating providers
LEAD introduces two-sided risk with prospective, population-based payments – meaning acute providers share in savings but are also accountable for excess costs. The model focuses on high-needs, medically complex Medicare beneficiaries, including those with multiple chronic conditions, functional limitations, high HCC risk scores, and dual eligibility.
For this population, PAC is not peripheral – it is central to both cost management and quality outcomes.
Several core components of the LEAD model make post-acute performance more consequential:
- SNF 3-day rule waiver: Eliminates the traditional inpatient stay requirement, expanding access to PAC and increasing utilization complexity
- Stable benchmarking: Enables long-term ROI from data, analytics, and care infrastructure capabilities
- Heightened care coordination expectations: Requires continuous tracking, earlier intervention, and tighter alignment across care settings
Capabilities that were once considered advanced – like real-time patient tracking, managing transitions from short-stay to long-stay populations, and identifying rising risk early – are now foundational to VBC success under LEAD.
Anthony Reed, VP of Strategic Partnerships, Real Time:
“To succeed in LEAD, acute providers and health systems have to shift from episodic thinking to long-term population ownership. That requires a deliberate investment in post-acute partnerships, real-time data, and care coordination capabilities that can scale over an entire decade.”
The post-acute blind spot that puts value-based outcomes at risk
Despite its growing importance in driving outcomes and cost, PAC remains one of the least visible parts of the continuum for most acute care organizations – creating a critical gap in managing value-based performance.
Once a patient is discharged to a skilled nursing facility or another care setting, visibility often drops off – replaced by a dependency on claims data that can lag by weeks or even months. In shorter-duration episode models, that delay can be managed. Over a 10-year accountability horizon, it becomes a compounding risk to both financial and clinical performance.
The scale of the challenge is significant:
- Nearly 40% of Medicare patients receive specialized nursing or rehabilitation care following discharge, yet real-time clinical visibility into that population remains limited
- PAC accounts for roughly 15% of total Medicare spending ($60 billion annually), making it a primary lever for managing total cost of care
- Nearly 1 in 5 Medicare patients are readmitted within 30 days of discharge – representing both avoidable cost and quality risk
These are not just system inefficiencies – they are missed opportunities to intervene and improve VBC outcomes.
Without real-time insight into what’s happening after discharge, care teams cannot detect deterioration early or intervene before complications arise. This becomes even more critical as patients transition from short-term rehabilitation into long-term care, where risk profiles and cost trajectories shift significantly.
Phyllis Wojtusik, RN:
“If your care team is unable to understand what is happening with your post-acute and long-term care populations as it happens, you are unable to impact it. This knowledge deficit only increases over time and can dramatically impact your quality (admissions, readmissions, post-acute length of stay) and financial outcomes. With the aging LEAD population, this can be crippling to the ACO.”
How real-time data powers proactive, long-term population health management
Succeeding under LEAD requires closing the post-acute visibility gap – and that demands more than retrospective data.
Real Time Medical Systems' (Real Time) interventional analytics solution addresses this challenge directly, delivering continuous, live clinical insights across the post-acute continuum. By integrating directly with SNF EHRs, the platform captures both structured and unstructured data and applies AI-driven analytics to identify subtle changes in patient condition as they occur.
When risk is detected, care teams receive immediate alerts and evidence-based intervention recommendations – enabling action before conditions worsen and helping prevent avoidable utilization that erodes value-based performance.
This supports a fundamental shift in how acute providers manage populations:
- From reactive to proactive: Intervening before deterioration leads to hospitalization
- From episodic to continuous: Maintaining visibility throughout the patient journey
- From siloed to coordinated: Aligning providers across settings with shared insights
Building effective care coordination under LEAD also requires consistent, bidirectional communication between acute and post-acute partners. With shared visibility into patient status and progression, providers can enable smoother transitions, identify discharge readiness sooner, and ensure patients are placed in the most appropriate care setting – improving both outcomes and cost efficiency over time.
The platform also enables providers to strengthen post-acute partnerships by delivering objective, real-time performance insights – helping organizations identify high-performing SNFs, reduce variability, and build aligned networks that consistently deliver VBC results.
The impact of Real Time’s solution and approach is measurable – and compounds over time in a 10-year model like LEAD:
- Up to 50% reduction in hospital readmissions (avg.), improving both cost and quality performance
- Up to 40% reduction in post-acute length of stay, helping optimize utilization and total cost of care
Anthony Reed:
“Over a 10-year model like LEAD, small gaps in visibility become significant performance challenges over time. The Real Time platform gives organizations the continuous clinical insight they need to stay ahead of risk and manage their populations with confidence.”
The long game starts now
LEAD begins January 1, 2027 – and preparation is already underway.
This model represents a structural shift from episodic results to sustained accountability for population health and value-based outcomes. Organizations that succeed will be those that invest early in a connected, data-driven approach – one that extends beyond the hospital and into post-acute settings where outcomes and costs are heavily influenced.
Real-time post-acute visibility is the foundation of that strategy. By equipping care teams with actionable clinical insights, enabling earlier intervention, and supporting more informed network decisions, Real Time helps acute providers manage risk across the full continuum of care delivery and drive stronger long-term VBC performance while navigating the decade ahead under LEAD.
For more information, visit www.realtimemed.com.