Payment Models We Support
VB Pay is purpose-built for value-based payment administration—engineered to handle the capitation, reconciliation, and compliance demands of CMS and CMMI models so risk-bearing entities can pay providers accurately and on time.
The CMS Innovation Center's ACO LEAD Model is the successor to ACO REACH. VB Pay will be ready to administer LEAD payments at go-live in 2027. We are actively building LEAD support as CMS finalizes program details, and we are fully prepared to support clients transitioning from ACO REACH to LEAD.
What LEAD introduces — and what we're building
Enhanced Primary Care Capitation (PCC)
Expanded primary care capitation arrangements with updated payment mechanics over the REACH model.
NPCC specialist sub-capitation
Non-Primary Care Capitation supporting sub-capitated specialist arrangements within the participating entity.
Whole-TIN participation
Payment handling that accommodates whole-TIN participation rather than individual-provider alignment.
Updated claims-reduction file handling
Ingestion and reconciliation against the model's revised claims-reduction file formats.
Multi-year benchmark trending
Benchmark tracking and trending across multiple performance years for accurate settlement.
Modified quality withhold & risk corridors
Configurable quality withhold calculations and risk-corridor logic aligned to LEAD parameters.
FQHC / RHC reconciliation
Reconciliation handling for Federally Qualified Health Centers and Rural Health Clinics.
Multiple reconciliation types
Support across PCC, TCC, APO, and NPCC reconciliation types within a single settlement workflow.
Supported Today
VB Pay administers payments across these value-based and CMS models in production today.
Medicare Shared Savings Program payment administration, including shared-savings settlement and provider distributions.
Full ACO REACH support—Primary Care Capitation, Total Care Capitation, claims-reduction reconciliation, and provider payments.
Capitated payment administration for risk-bearing entities operating outside of ACO programs.
Pre-adjudicated, fee-for-service replacement payments that pay providers on a value-based schedule instead of traditional FFS.
Primary Care Flex prospective payments for MSSP ACOs, supporting the model's advanced primary care capitation.
Not sure how your model maps to VB Pay?
Whether you're running MSSP today or planning your ACO REACH to LEAD transition, our team can walk you through how VB Pay administers your payments.