As the Kidney Care Choices (KCC) model heads toward its 2027 sunset, the nephrology community is eyeing CMMI's new LEAD model as a potential successor — but experts say that's the wrong read. LEAD is a primary care-focused ACO model, not a kidney-specific framework, and CMMI has explicitly stated it's not a replacement for KCC. The real takeaway? LEAD's design features offer a blueprint for what the next kidney-specific model could look like.
With the Kidney Care Choices (KCC) model set to sunset at the end of 2027, the nephrology world is navigating a critical transition in value-based care. Enter LEAD (Long-term Enhanced Accountable Care Organization Design) — CMMI's newly announced successor to ACO REACH, launching January 1. The timing has sparked speculation that LEAD could serve as the next home for kidney care, but CMMI has been clear: it's not.
LEAD is built around primary care ACOs and broad Medicare populations, not the specialized, nephrologist-led accountability that defines KCC. In fact, joining LEAD as a core participant would currently require practices to exit KCC entirely — a significant trade-off. CMMI has explicitly stated it sees value in continuing nephrology-led care and is not viewing LEAD, in its current form, as a viable pathway for kidney-specific total cost-of-care risk.
That said, LEAD isn't irrelevant to nephrology — it's instructive. Its design offers key signals for what a future kidney model could look like:
Why it matters: The kidney care community shouldn't rush into LEAD, but it should study it closely. LEAD's innovations — from its long timeline to specialty integration tools — could serve as the foundation for a more robust, next-generation kidney-specific model.
