In 2021, CMS set a goal of having every person with traditional Medicare in an accountable care relationship by 2030. As of January 2025, CMS reported that 53.4 percent were there, or more than 14.8 million people. Dementia care is not the center of that effort, but it sits inside it, and CMS has built one model, GUIDE, specifically for it.
This guide explains what an accountable care relationship is, how far the goal has come, what has changed in CMS's strategy since, and where dementia care programs fit. It is written for provider teams, program leads and operators planning around value-based payment.
What Is an Accountable Care Relationship?
CMS describes it as a longitudinal relationship with providers who are responsible for the quality and total cost of a person's care. Accountable care requires access to and coordination of primary and specialty care to meet the full range of a patient's needs.
CMS's count includes people whose providers are in accountable care organizations (ACOs), including the Medicare Shared Savings Program and Innovation Center accountable care models. It also includes other Innovation Center models focused on total cost of care, advanced primary care and specialty care.
Where the 2030 Goal Came From, and How Far It Has Come
The Innovation Center's 2021 strategic refresh set the target of every traditional Medicare, or fee-for-service, beneficiary in an accountable care relationship by 2030. CMS said the goal was not only about value-based payment arrangements. It was about care arrangements where a person's needs are holistically assessed and their care is coordinated within a broader total cost of care system.
Progress has been steady. According to a CMS fact sheet, 53.4 percent of people with traditional Medicare were in an accountable care relationship as of January 2025, which is more than 14.8 million people. That was a 4.3 percentage point increase from January 2024 and the largest annual increase CMS had recorded since it began tracking.
Does the 2030 Goal Still Stand?
The answer needs care. In May 2025, CMS published a new strategic direction for the Innovation Center. Health Management Associates, summarizing it in December 2025, described the strategy as emphasizing evidence-based prevention, consumer engagement and tech-enabled care, while prioritizing financial performance over broad participation. HMA noted that the new strategy hadn't provided a numeric goal like the 2030 target, and that it was unknown whether one would follow.
That isn't the same as stepping back from accountable care. A Health Affairs Forefront analysis says the current administration has signaled a continued commitment to accountable care, pointing to the Innovation Center's announcement of the Long-term Enhanced ACO Design (LEAD) Model.
So the accurate summary is that the 2030 target was set in 2021, CMS hasn't restated it in the same terms in the sources reviewed for this article, and CMS is still building accountable care models. Check CMS directly for any updated target before citing one.
What LEAD Adds
CMS's LEAD model is a voluntary, 10-year ACO model that runs from January 1, 2027, through December 31, 2036, and it replaces ACO REACH. CMS describes it as offering a predictable window without rebasing of financial benchmarks. It is designed to appeal to a broader mix of providers, including those with specialized patient populations and those new to ACOs, such as smaller, independent or rural practices.
CMS also says LEAD will focus on better coordinated care for high-needs patients, such as people who are dually eligible for Medicare and Medicaid and people who are homebound or home limited.
CMS doesn't describe LEAD as a dementia model. Dually eligible and homebound patients are groups that dementia programs serve, though, and GUIDE includes dually eligible patients, so the model is worth watching if you work with ACOs.
A Caveat on the Progress
Not everyone sees the 53 percent figure as a finish line. Definitive Healthcare's April 2026 analysis notes that the milestone comes with caveats. It says many participating providers remain insulated from meaningful downside risk, and that CMS is reshaping its model portfolio by expanding some programs, retiring others and redesigning others.
The accountable care count also covers only traditional Medicare. People in Medicare Advantage aren't part of the 53.4 percent figure, and GUIDE also excludes them.
Where Dementia Care Fits
CMS identified dementia care as a gap. In a Health Affairs Forefront piece on the Innovation Center's strategy, CMS officials said that in searching for areas of pressing need, they identified dementia care as a gap where new ways of delivering and paying for care could measurably improve people's lives. GUIDE is CMS's dementia care model.
GUIDE is a separate track. GUIDE is an eight-year model that began in July 2024. It pays a monthly dementia care management payment, adjusts it based on five performance measures, and includes a measure of total per-capita cost. CMS's accountable care fact sheet doesn't list GUIDE among the models it counts, so you shouldn't assume that GUIDE participation counts toward the 53.4 percent figure.
People with dementia are likely to be in accountable care too. A patient with dementia can be attributed to an ACO for their overall care, and CMS's accountable care approach makes providers responsible for total cost and quality. Dementia is costly. The Alzheimer's Association's 2026 report projects $409 billion in health and long-term care costs for people with dementia, and it expects Medicare and Medicaid to pay 64 percent of that. For an ACO, avoidable spending on this population is a real issue.
Dementia care is a hard case for accountable care. Much of the work sits outside the clinic. Caregivers provide most of the care, and needs change between visits. That is why GUIDE includes caregiver training, respite and a caregiver-impact measure.
What Dementia Care Programs Can Do
Learn the total cost of care lens. ACOs and GUIDE both look at cost and utilization, so fluency in measures like total per-capita cost and observed-to-expected ratios helps in any conversation with a payer or ACO.
Be ready to describe what happens between visits. Accountable care depends on coordination, and an ACO or health system evaluating a dementia partner will want to know how patients and caregivers are supported day to day.
Watch the model calendar. LEAD begins January 1, 2027, and ACO REACH ends December 31, 2026. Both affect who your referral partners are and how they are paid.
Cite carefully. Name the source and the date for any accountable care statistic, and don't present the 2030 goal as current CMS policy without checking.
Our Value-Based Care page and GUIDE page cover how these models work for provider teams.
Where Elli Cares Fits
Accountable care relies on organizations knowing what is happening to patients when they aren't in the clinic. Elli Cares gives dementia care teams a clinician dashboard, AI-generated summaries, daily wellbeing check-ins, medication reminders and family observations, so they can see who may need earlier outreach. Elli doesn't make an organization eligible for any CMS model, and it doesn't guarantee lower costs or better outcomes. It supports the between-visit visibility that coordinated care depends on.
Frequently Asked Questions
What is an accountable care relationship?
A longitudinal relationship with providers who are responsible for the quality and total cost of a person's care, according to CMS. It includes ACOs and other models focused on total cost of care, advanced primary care and specialty care.
What percent of Medicare beneficiaries are in accountable care?
CMS reported that 53.4 percent of people with traditional Medicare were in an accountable care relationship as of January 2025, more than 14.8 million people.
Is the 2030 accountable care goal still in effect?
CMS set the goal in 2021. Health Management Associates noted in December 2025 that CMS's May 2025 strategy hadn't provided a comparable numeric target, though CMS continues to develop accountable care models such as LEAD. Check CMS for any updated target.
Does GUIDE count as an accountable care relationship?
CMS's accountable care fact sheet doesn't list GUIDE among the models it counts. GUIDE is a dementia-specific payment model for people with Original Medicare that adds care coordination and caregiver support.
What is the LEAD Model?
A voluntary, 10-year ACO model that runs from January 1, 2027, through December 31, 2036, and succeeds ACO REACH. CMS says it is designed to appeal to smaller, independent and rural practices and to focus on high-needs patients, such as people who are dually eligible or homebound.
