LEAD is the successor to REACH — a 10-year CMS program with full upside and downside risk, capitated cash flow from day one, and operational requirements that demand a purpose-built operating system. Nightingale was built on exactly these requirements.
All programs share the same foundation: PCP-based attribution and Part A & B claims accountability. What changes is how much you capture, how cash flows, and the operational breadth required.
LEAD carries forward the foundation of REACH with new features that increase both the upside and the operational demands.
Complete financial accountability — you capture savings when you perform, and share in losses when you don't. The incentive to get it right is absolute.
Claims payments flow through the ACO, not the Medicare Administrative Contractor. Predictable, substantial operating revenue from Performance Year 1.
Patients are assigned before the start of the performance year. You know your population, your risk, and your accountability from day one.
Heightened audit and monitoring requirements from CMS. Compliance isn't optional — it's a daily operational discipline that requires purpose-built infrastructure.
CMS is moving to claims-based quality measures for PY27, reducing reporting burden while maintaining financial impact. Quality still drives economics — execution still matters.
This isn't a pilot. LEAD is a decade-long commitment from CMS — creating long-term stability for organizations willing to invest in doing it right.
Understanding the per-patient, per-month economics is essential. Here's what the financial model looks like based on Florence Provider Network actuals.
| Line Item | Per Patient / Month |
|---|---|
| Net County Rate PMPM | $1,482 |
| Less: CMS Discount (4%) | ($59) |
| Less: Quality Withhold (3%) | ($44) |
| Plus: Quality Earnback (@ 90%) | $40 |
| Net Capitated Revenue | $1,418 |
| Claims Paid | ($1,153) |
| Non-Claim Based Payments | ($53) |
| Net Surplus | $213 |
Based on Florence Provider Network actuals. Net County Rate varies by patient county rate category, risk score, alignment mechanism, and ACO baseline factors.
Florence Provider Network, REACH ACO actuals — demonstrating how the model scales from 42 to 72 PCPs and from $84M to $285M in revenue.
| PY2024 | PY2025 | PY2026 | |
|---|---|---|---|
| PCPs | 42 | 42 | 72 |
| Attributed Lives | 4,800 | 8,100 | 15,100 |
| Revenue (Net Capitated) | $84.4M | $141.8M | $284.9M |
| Total Medical Expense | ($71.1M) | ($120.5M) | ($242.1M) |
| ACO-Captured Savings | $13.3M (15.8%) | $21.3M (15%) | $42.7M (15%) |
PY2026 ACO-Captured Savings shown at LEAD-equivalent amount. PY2026 TME shown as current conservative underwriting guardrails.
Nightingale brings proprietary, practice-level underwriting expertise to every potential partnership — determining whether the opportunity is real before anyone commits. It's the same discipline that built a $280M+ book of business with zero outside capital.
Learn about our underwritingNightingale is the only platform that was built and proven inside the exact program LEAD succeeds. This isn't theoretical — it's operational DNA.
Every operational, compliance, and financial requirement from REACH carries forward into LEAD. Nightingale already does all of it — in production, at scale.
Powered Florence Provider Network to 15–17% sustained savings, top-percentile quality, and CMS High Performers Pool qualification. Verified, program-level results.
Claims payment, clinical workflows, compliance, finance, quality, attribution, provider engagement — one unified system, not a dozen stitched-together vendors.
LEAD's capitated payment structure means partners have budget and rational incentive to invest in the right operating system from day one.
Nightingale arrives with a proprietary business case built on your data — so you know the opportunity is real before you commit.
PMPM base fee plus a percentage of upside. Nightingale wins when you win. This isn't a flat SaaS fee disconnected from your outcomes.
"Everybody has a plan until you get punched in the face."
Nightingale can take your organization from consideration to a fully operational ACO LEAD — with the proven platform, underwriting expertise, and embedded support to de-risk the entire journey.