The last two years have dramatically strengthened the ACO role in providing accountable care. New CMS specialty payment models—TEAM, ASM, and the proposed CJR-X—each include specific provisions for ACO coordination and referrals, extending the ACO’s reach deep into the specialty care continuum. LEAD, the new long-term ACO model with prospective payments, has redefined the future of the ACO as the hub of accountable care, with specialty integration built into its architecture. Quality reporting requirements have tightened. Data obligations have expanded. And beneath all of it, a fundamental question persists: is your organization actually built for what comes next?
Most of the guidance available to ACO leaders focuses on compliance—how to report, how to avoid penalties, how to survive the next rule cycle. That guidance has its place. But it does not answer the harder questions:
- How do you build an organization that thrives in a Value-Based Care ecosystem and serves as its hub?
- How do you manage total cost of care and episodic risk for the same patients at the same time?
- How do you prepare for specialty payment models when your technology and workflows were designed for primary care population health?
- How do you extend your ACO’s reach into the 359 days a year when your highest-risk patients are making decisions—about food, movement, medication, and habits—without anyone from your care team present?
We wrote this guide to address those questions directly. It collects five Roji Intel articles published over the first half of 2026, each building on the last—from the mandatory model landscape, to the analytics challenge, to the technology imperative, to the human question at the center of it all: What does the ACO owe its patients beyond claims management and quality reporting? Together they form a practical guide for ACO and health system leaders willing to step into the complexity ahead—not manage around it.
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