The Kidney Care Choices (KCC) model is scheduled to sunset at the end of 2027, creating a transition period for nephrology’s value-based care framework. While the CMS Innovation Center (CMMI) recently introduced the LEAD (Long-term Enhanced Accountable Care Organization Design) model as a successor to ACO REACH, CMMI has explicitly stated that LEAD is not a replacement for the kidney-specific KCC model.
CMMI Clarifies LEAD Model is Not a KCC Replacement
Confusion recently surfaced within the nephrology community regarding whether the LEAD model serves as the “off-ramp” for the KCC model. In a June 9 KCC newsletter, the CMS Innovation Center (CMMI) clarified that it is not contemplating LEAD, in its current form, as a viable pathway for nephrology total cost of care risk. CMMI officials emphasized a continued focus on nephrology-led care for beneficiaries with kidney disease.
The LEAD model is designed primarily for primary care-focused accountable care organizations (ACOs). It is positioned as the successor to ACO REACH (Accountable Care Organization Realizing Equity, Access and Community Health), which is set to end on December 31. Because LEAD begins on January 1 and KCC sunsets one year later, the timing overlap prompted questions about the future of specialized kidney care risk management.
Structural Differences Between KCC and LEAD
The primary disconnect between the two models lies in how they organize provider accountability and patient alignment.
- LEAD Model: Centers on primary care professionals. Beneficiaries are aligned through established primary care relationships. While it can include patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), the model treats specialty care as a “spoke” in a broader ACO wheel.
- KCC Model: Places nephrologists at the helm. It is engineered specifically for the complexities of CKD and ESKD, offering financial incentives for kidney-specific quality goals, such as increasing home dialysis training and transplant rates.
A critical constraint for practices is that current rules would require a provider to withdraw from KCC entirely to become a core participant in LEAD.
Analyzing the Future of Specialty Care via LEAD
Although LEAD isn’t a direct replacement, it provides a blueprint for how CMMI may design future specialty-specific models. Three specific elements of LEAD signal a shift in CMS strategy:
- 10-Year Runway: LEAD is a decade-long model. This suggests CMMI recognizes that meaningful clinical change in complex populations requires long-term stability rather than short-term pilots.
- High-Needs Focus: The model’s explicit attention to high-needs beneficiaries reinforces the necessity of intensive coordination for conditions like ESKD.
- Specialty Integration: The introduction of CMS-Administered Risk Arrangements (CARA) allows LEAD ACOs to enter episode-based risk arrangements with specialists. This provides a structured mechanism to bring specialists into total cost-of-care accountability without removing them from their specialty-led frameworks.
Comparison: KCC vs. LEAD Framework
| Feature | Kidney Care Choices (KCC) | LEAD Model |
|---|---|---|
| Primary Focus | Nephrology-led specialty care | Primary care-led ACOs |
| Patient Alignment | Kidney-specific (CKD/ESKD) | Broad Medicare population |
| Core Incentives | Home dialysis, transplants, optimal starts | General population health management |
| Duration/Timeline | Sunsets end of 2027 | 10-year duration |
Nephrologists may still participate in LEAD as “preferred providers,” allowing them to partner with primary care ACOs without abandoning the specialized framework of KCC. As the 2027 deadline approaches, the industry is looking toward a future model that blends the long-term stability of LEAD with the clinical specificity of KCC.