Medicare ACOs set new savings record

CMS analyzed data from 476 ACOs participating in the MSSP. These ACOs represented 80% of the 10.3 million beneficiaries assigned to an ACO.

Of the 476 ACOs, 75% earned performance payments totaling $4.1 billion and resulted in Medicare savings of $2.4 billion in 2024. According to CMS, this is the highest share of ACOs receiving performance payments and the highest amount of savings for ACOs and Medicare since the inception of the MSSP.

However, CMS also noted that 16 ACOs had $20.3 million in collective shared losses.

In 2024, ACOs had $241 in net per capita savings compared to $207 in 2023. Similarly, ACOs had $643 in gross per capita savings in 2024 compared to $515 in 2023. Net per capita savings represent Medicare savings while gross per capita savings represent savings shared by ACOs and Medicare.

CMS also found that low-revenue ACOs continue to outperform high-revenue ACOs, with low-revenue ACOs generating $316 in net per capita savings compared to $175 for high-revenue ACOs. According to Healthcare Finance, low-revenue ACOs are typically led by physicians or are comprised of federally qualified health centers/rural health clinics. In comparison, high-revenue ACOs are usually hospital-led.

ACOs that were predominantly made up of primary care physicians also performed better than those with fewer physicians ($401 in net per capita savings vs. $219, respectively).

ACOs also provided high-quality care, with beneficiaries seeing improvements in blood pressure and A1c levels. ACOs reported an increase in the mean percentage of patients with adequately controlled high blood pressure and a decrease in the mean percentage of patients with poor hemoglobin A1c control.

In addition, CMS noted that "[n]early all ACOs outperformed similar types of physician groups on quality measures." For example, an average of 55.4% of ACO patients who were screened for depression had a follow-up plan established while only 44% of patients with similar organizations under the Merit-based Incentive Payment System had one.

In a statement, the National Association of ACOs (NAACOS) applauded the results, and said that it would continue working with CMS and other stakeholders to ensure the long-term sustainability of ACOs.

"The results show ongoing measurable success in improving high-quality, coordinated care that addresses prevention, chronic illness and the root causes of disease," said NAACOS president and CEO Emily Brower.

Although there are still challenges and potential setbacks to VBC, Advisory Board's Clare Wirth said that "the root causes that created momentum for VBC in the first place have only been exacerbated," with the latest indicating that "14% of nationwide provider reimbursement is tied to delegated or capitated risk models, double from what it was just three years prior."

"The shared savings model isn't going to close the gap with Medicaid cuts and erosion in enrollment, but this is really about having better insight into the global experience that our patients have and better tailoring care to those patients," said Cook County CEO Eric Mikaitis.

"We'll have a more complete understanding of a patient’s experience, even outside of Cook County Health, to inform a better conversation with the primary care and care coordination teams around what that patient really needs," Mikaitis added. "As we standardize our care coordination, we are seeing this erosion of Medicaid coverage and people now being uninsured. Those are the folks who are going to need better care coordination. We can help stop them from just using the emergency department for primary care."