MSSP or an Innovation Center model, and how much risk? This lesson maps the options and the current landscape, which is shifting in 2027.
An organization ready to form an ACO faces a first fork: which program, and at what level of risk? The answer shapes everything downstream, and the landscape is shifting, so getting the current picture right matters.
The two homes for an ACO
- The Medicare Shared Savings Program (MSSP) is the permanent program, written into statute. It is the default home for most ACOs and does not expire.
- CMS Innovation Center models are time-limited demonstrations that test more advanced designs, often with more risk and more flexibility than MSSP.
MSSP tracks
MSSP offers two tracks over five-year agreements:
- The BASIC track includes a five-level glide path (Levels A through E) that lets an ACO start in a one-sided model (savings only) and step up to two-sided risk over time. It is the on-ramp for organizations new to accountability.
- The ENHANCED track carries the highest level of risk and the highest potential reward, for experienced organizations ready to take on substantial downside.
A recent change matters for planning: for agreement periods beginning on or after January 1, 2027, CMS shortened the maximum time an eligible ACO can stay in a one-sided BASIC model to five performance years, tightening the on-ramp to push organizations toward two-sided risk sooner.
The Innovation Center track is changing
The advanced-model landscape is in transition, which anyone choosing today must know:
Worth remembering: ACO REACH, the Innovation Center’s flagship ACO model, concludes at the end of 2026. Its successor, the Long-term Enhanced ACO Design (LEAD) Model, is a ten-year model beginning January 1, 2027, built to appeal to a broader range of providers, including smaller, independent, and rural practices and those new to accountable care. Any “which model” decision made now has to account for that handoff.
How to choose
The decision comes down to a few questions the rest of this course helps answer:
| Question | Points toward |
|---|---|
| New to accountability, limited capital? | MSSP BASIC glide path (one-sided start) |
| Experienced, ready for downside? | MSSP ENHANCED or an advanced model |
| Want more flexibility and capitation-like features? | An Innovation Center model (LEAD from 2027) |
Risk appetite, capital, data maturity, and experience all feed the choice. A capable organization can start conservatively and climb, exactly the developmental path the finance course described for moving along the risk spectrum.
Key takeaways
- ACOs live in the permanent MSSP or in time-limited Innovation Center models.
- MSSP offers the BASIC glide path (one-sided to two-sided) and the higher-risk ENHANCED track; the one-sided on-ramp tightens for agreements from 2027.
- ACO REACH ends after 2026 and is succeeded by the ten-year LEAD Model in 2027; verify the current model landscape before choosing.
Sources
Check your understanding
As of 2026, what is happening to the ACO REACH model?
CMS announced that ACO REACH ends after 2026, replaced by the Long-term Enhanced ACO Design (LEAD) Model starting January 1, 2027. The permanent Medicare Shared Savings Program continues alongside it.