Achieving change to established federal health policy is, for the most part, a long game—and for those of us focused on ensuring aging services providers have a meaningful role in value-based care, this tenet most certainly applies.

Wins are hard-earned over time. The good news is that recent Center for Medicare and Medicaid Services (CMS) and Center for Medicare & Medicaid Innovation (CMMI) developments related to value-based care—a relatively new approach to measure, reward, and pay providers for services delivered—are a clear reminder that sustained, strategic advocacy does pay off.

A good example is the CMS’ Long-term Enhanced Accountable Care Organization Design (LEAD) Model, scheduled to launch January 1, 2027—the successor the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. It incorporates several policies, like lower barriers to participation for organizations serving high-needs populations, infrastructure support for providers entering risk-based arrangements, and CMS-Administered Care Arrangements (CARA) designed to make it easier for aging services providers to participate in value-based partnerships, all championed by LeadingAge through comment letters, meetings with the CMS and the Center for Medicare and Medicaid Innovation (CMMI), and collaboration with our members and other provider partners.

LEAD’s focus on care coordination, population health, and beneficiaries with complex needs—all critical components of aging services providers’ work—is the result of our long-standing efforts to get CMS to recognize post-acute care’s contributions and role, and reward them for the value they bring to improving outcomes and lowering costs across the care continuum.

LEAD is one of many efforts shaped over the past decade by LeadingAge’s consistent engagement with CMS and CMMI to ensure our members are not sidelined as new payment and delivery models are designed. This is important work: value-based care is growing, and early models too often positioned nursing homes, home health agencies, and other aging services providers on the periphery. Though LeadingAge members and other providers of aging services are essential participants in service delivery, they were without meaningful opportunity to lead or share in the financial rewards tied to improved outcomes and lower costs.

LeadingAge knew that had to change. After all, aging services providers bring a unique and essential set of capabilities to value-based care: Our members manage complex, chronically ill populations, coordinate care across settings, and deliver services that are critical to avoiding unnecessary hospitalizations and improving quality of life—precisely the outcomes CMMI models strive to achieve.

Armed with that positive foundation, our advocacy approach is, and has been, proactive. We regularly convene members who have real-world experience in risk-based arrangements for discussions to help define what successful models and opportunities should look like. We partner with other provider associations through the Post-Acute Care (PAC) coalition to amplify our advocacy voice and to present recommendations to policymakers as a unified front. The models we’ve proposed allow post-acute and long-term care providers to not only participate, but to lead.

These have ranged from practical, near-term solutions—like testing episodic payments that support direct admissions to skilled nursing facilities without a three-day hospital stay—to more advanced concepts, including population-based payment models for providers ready to assume broader financial accountability.

At every step, we keep our goals in mind:

• To create pathways for aging services providers to gain experience with value-based care.
• To ensure opportunities for our members to lead innovative care delivery models.
• To ensure–at a minimum–that providers are fairly compensated for the value they contribute, whether they are in the lead role or not.

The impact of years of effort is clear.

CMMI—established in 2010 with a mandate and dedicated funding to test new models of care—has continuously evolved its portfolio based on lessons learned. Many of the concepts we’ve supported and promoted have been incorporated in model design: greater emphasis on care coordination, recognition of aging services providers’ role in managing total cost of care, and growing interest in alternative payment structures that extend beyond hospitals and physician groups.

From ACOs to bundled payments, primary and specialty care initiatives, today’s models reflect a broader understanding of what’s needed to improve outcomes for older adults. And as CMS moves toward its goal of placing all Medicare beneficiaries in accountable care relationships, fully integrating aging services providers into these models is increasingly important.

Perhaps most telling is the evolution of ACO models themselves. Starting with Pioneer and moving to Next Generation, Direct Contracting, ACO REACH—and soon, to the LEAD model, each iteration has brought new opportunities to rethink how care is organized and delivered. Increasingly, these models recognize the need for partners who can manage complex patients across settings and over time—precisely where LeadingAge members excel.

There is still work to do. Barriers remain, and not all models yet fully reflect the vision we have advanced. But the trajectory is unmistakable. The ideas we put forward—often years ago—are now embedded in the policy conversation and, increasingly, in the models themselves. Many of these models now allow aging service providers to lead, take risks, and participate in the financial rewards of value-based and accountable care.

For those of us who sometimes wish change would happen faster, this is an important reminder: policy transformation is not a sprint. It is a relay marathon that rewards participants’ persistence, collaboration, and unyielding focus on a clear vision of a desired future. And thanks to the perseverance of LeadingAge members and partners, that future is beginning to take shape.