ACOs saved $2.4 billion in 2024, data shows

Accountable Care Organizations saved Medicare $2.4 billion relative to benchmarks in 2024, and most ACOs are earning performance payments in the billions, according to Medicare Shared Savings Program data released by the Centers for Medicare and Medicaid Services.

Out of 476 ACOs, 75% of them, representing 80% of the 10.3 million assigned beneficiaries, are earning performance payments totaling $4.1 billion, data showed.

Payment year 2024 had the highest share of ACOs receiving performance payments and the highest amount of savings for ACOs and Medicare since the inception of the MSSP, CMS said.

WHAT'S THE IMPACT

ACOs had higher savings per capita in payment year 2024, compared to 2023 – $241 versus $207 in net per capita savings and $643 versus $515 in gross per capita savings, respectively.  Net per capita savings represent the savings for Medicare, whereas gross per capita savings are the savings shared by ACOs and Medicare.

Low-revenue ACOs continue to outperform high-revenue ACOs, generating $316 versus $175 net per capita savings. Low-revenue ACOs are typically physician-led ACOs or are comprised of federally qualified health centers/rural health clinics (FQHC/RHCs), while high-revenue ACOs are typically hospital-led. ACOs composed predominantly of primary care clinicians performed better than ACOs with fewer primary care clinicians, with $401 versus $219 in net per capita savings.

ACOs that achieved shared savings had lower utilization compared with their benchmark across many categories of utilization, including hospital discharges, Emergency Department visits and Skilled Nursing Facility stays.

Sixteen ACOs owed shared losses totaling $20.3 million, CMS said.

In terms of performance, nearly all ACOs continued to meet quality reporting requirements. Shared Savings Program ACOs helped more patients improve markers of good health, such as controlled blood pressure and depression screening with a follow-up plan, compared with 2023. ACOs also outperformed comparable physician groups on these metrics, CMS said.

THE LARGER TREND

In the 2026 Physician Fee Schedule Proposed Rule released in July, CMS is proposing to reduce the length of time an ACO can participate in a one-sided model of the BASIC track to a maximum of five performance years – the length of the ACO's first agreement period in the BASIC track's glide path (if eligible), rather than a maximum of seven performance years. 

CMS also is proposing modifications to the eligibility requirements that ACOs have at least 5,000 assigned Medicare fee-for-service beneficiaries; this is to increase flexibility regarding the minimum number of assigned beneficiaries required in benchmark years, while establishing safeguards to protect the Medicare Trust Funds and ACOs from normal variation in expenditures, said CMS.