Accountable care aligns payment to improved patient outcomes and lower cost of care because providers are accountable for quality and cost. In these models, health care providers are paid for activities with proven benefits for patients (coordination of care, timely follow ups, etc.) that fee-for-service payment either lacks or undervalues.
Accountable Care Models in Medicare Have a Long Track Record of Better Care at a Lower Cost
For over a decade, the Centers for Medicare and Medicaid Services (CMS) and the CMS Innovation Center have deployed “accountable care organizations” (ACOs), which are groups of clinicians who work together to provide high-quality, coordinated care for patients, improve health outcomes, and manage costs. Since its inception, the Innovation Center has operated ACO models alongside the statutory Medicare Shared Savings Program and these accountable care options have continuously delivered savings to the Trust Fund and better outcomes for patients.
ACO Savings Results
| MSSP 2012-present | $6.5 billion in savings in 2024, estimated total of $13 billion in savings including spillover effects |
| Pioneer ACO Model 2012-2016 | 2.5% savings |
| ACO Investment Model 2015-2018 | 3.4% savings |
| Next Generation ACO Model 2016-2021 | 1.9% savings |
Incentives for Accountable Care in “Full Risk” Model
The accountable care options offered through the Innovation Center have different features that allow organizations to succeed on behalf of their patients. These ACO options are “full risk” models that allow providers to share in 100% of the upside and downside financial results, subject to a discount that guarantees savings to Medicare. In addition, these models include different features such as capitated payments and the ability to engage providers and patients in different approaches to care coordination not currently available in traditional Medicare.
Full Risk Option for ACOs Should Be Made Permanent
The current full risk ACO option, ACO REACH, is scheduled to end after 2026. Accountable for Health seeks support for legislation that would make this option a permanent part of the Medicare program.
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CMS’s 2024 results show that ACO REACH generated nearly $1 billion in net savings while improving quality and supporting better coordinated care for 2.5 million Medicare beneficiaries. This issue brief highlights the model’s growing financial performance, strong results for High Needs ACOs, and continued progress on key measures of patient care.
This bill creates a permanent ACO option for organizations that want to participate in “full risk.” This program would operate as an additional option alongside the Medicare Shared Savings Program, expanding opportunities to participate in two-sided risk.
From uncovering abuses to securing reform, A4H led a coordinated campaign to expose waste, protect patients, and support CMS’s efforts to bring accountability to the skin substitute market.
