One view across levels of need
Support eligible Aged and Disabled, ESRD, and High Needs populations without reducing the model to a single segment.
For payers, public partners, and aligned organizations
A clinically accountable operating partner.
Sphere Health Partners brings clinical operations, access pathways, quality discipline, and data-enabled coordination into one model built around the needs of eligible Original Medicare populations.
LEAD is a CMS Original Medicare model. Medicare Advantage, commercial, and Medicaid relationships require separate authority and agreements.
Clinical depthPrevention through complex care
Access designCare across settings and communities
Quality disciplineDefined measures and improvement work
AccountabilityClear ownership, governance, and review
The operating proposition
Clinical infrastructure around the whole person.
Value-based performance depends on daily care delivery, not financial mechanics alone. Sphere's model connects the clinical, access, coordination, and information work that accountable care requires.
Prevention through complexity
Align preventive care, chronic-condition management, complex care, pharmacy, behavioral health, and transitions.
The right setting for the need
Combine practice, home, virtual, specialty, post-acute, and community pathways when clinically appropriate.
From signal to owned action
Translate authorized data and care events into prioritized work, clear responsibility, and closed-loop follow-through.
LEAD boundary
Original Medicare is the center of this model.
Clear product and program boundaries prevent a CMS model from being mistaken for a commercial or managed-care offering.
CMS accountable care
LEAD aligns eligible people in Original Medicare to participating ACOs and holds those ACOs accountable for defined quality and total cost of care.
Not Medicare Advantage
People enrolled in Medicare Advantage or another Medicare managed-care plan are not eligible for LEAD alignment under current CMS rules.
Separate payer relationships
Any Medicare Advantage, commercial, employer, or other payer arrangement would be a separate Sphere relationship with its own authority, economics, network terms, and operating design.
Medicaid coordination is conditional
LEAD's dually eligible integration component depends on CMS and selected-state planning, formal partnership agreements, and compliant data and risk-sharing arrangements.
Accountable performance
The operating system aligns around outcomes.
The quality model creates a direct line from population needs to clinical actions, patient experience, and accountable review.
Measures become workflows.
Connect readmissions, unplanned admissions, timely follow-up, days at home, chronic-condition control, and experience to owned care work.
Reach becomes clinical design.
Match delivery settings, communication, community resources, and caregiver support to the population rather than relying on a single channel.
Performance becomes a learning loop.
Review outcomes, workflow completion, patient feedback, utilization, and variation to strengthen clinical practice over time.
Data and trust
Information moves only to improve accountable care.
Partner confidence requires useful information, clear authority, defensible governance, and an auditable route from data to action.
Standards-based connectivity
Authorized exchange connects practices, hospitals, specialists, post-acute providers, public partners, and the ACO.
Longitudinal population view
Bring clinical, claims, pharmacy, care-setting, and social context together where permitted and necessary.
Purpose-bound access
Use role-based access, minimum-necessary principles, traceable actions, and clear data-use responsibilities.
Transparent performance
Create a shared view of definitions, attribution, quality work, open issues, and accountable next actions.
Partnership design
Responsibilities before rhetoric.
A credible partnership starts with exact populations, authority, services, risks, data, and clinical responsibility.
Population and eligibility
Define who is in scope, how they are aligned, and which program or agreement authorizes the relationship.
Clinical and service scope
Specify who delivers each service, who retains clinical authority, and where duplication or gaps could occur.
Quality and economics
Align measures, methodologies, settlement logic, risk, and performance review without promising results in advance.
Data and governance
Document permitted uses, access, security, audit, issue escalation, oversight, and change control.
LEAD and Medicare–Medicaid descriptions are based on current CMS materials. No payer product, state partnership, savings result, or LEAD participation is represented as finalized here.