2024 ACO performance surges: Higher savings, better quality, lower utilization 

WASHINGTON – Accountable care organizations (ACOs) in the Medicare Shared Savings Program achieved the highest rates of shared savings since the inception of the program, CMS has announced. 

For performance year 2024, 75% of ACOs out of a total of 476 – representing 80% of the 10.3 million assigned beneficiaries – are earning performance payments totaling $4.1 billion, the agency says. Medicare saved $2.4 billion relative to benchmarks, it says. 

Financial results 

• ACOs had higher savings per capita in PY 2024 compared to PY 2023, $241 vs $207 in net per capita savings and $643 vs $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 vs $175 net per capita savings. Low revenue ACOs are typically physician-led ACOs or are comprised of FQHC/RHCs, while high revenue ACOs are typically hospital-led. ACOs composed predominantly of primary care clinicians performed better compared to ACOs with fewer primary care clinicians, with $401 vs. $219 in net per capita savings. 
• ACOs that achieved shared savings had lower utilization compared to their benchmark across many categories of utilization, including hospital discharges, emergency department visits and skilled nursing facility stays. 
• 16 ACOs owed shared losses totaling $20.3 million. 

Quality results 

• Nearly all ACOs continued to meet quality reporting requirements, and adoption of all-payer digital quality measures increased from PY 2023. CMS continues to encourage ACOs to move toward reporting digital quality measures using electronically stored and transmitted health information, leveraging interoperability, reducing burden and improving efficiency. 
• Shared Savings Program ACOs helped more patients improve markers of good health, such as controlled blood pressure, hemoglobin A1c control (an indicator for diabetes), and depression screening with a follow-up plan, compared to 2023. 
  • Among ACOs that reported quality measures via the CMS Web Interface, the mean percentage of beneficiaries with adequately controlled high blood pressure increased significantly from PY 2023 to PY 2024 (from 77.8% to 79.49%). 
  • Among ACOs that reported CMS Web Interface measures, the mean percentage of beneficiaries with poor hemoglobin A1c control also declined significantly from PY 2023 to PY 2024 (from 9.84% to 9.44%). 
  • Among ACOs that moved toward reporting digital quality measures, and reported all-payer MIPS CQMs, significant improvements were seen from PY 2023 to PY 2024: 
    • The mean percentage of patients with adequately controlled high blood pressure increased (from 69.63% to 73.65%). 
    • The mean percentage of patients with poor hemoglobin A1c control declined (from 35.18% to 23.52%). 
    • The mean percentage of patients screened for depression and for whom a follow-up plan was documented increased (from 43.70% to 55.36%). 
• Nearly all ACOs outperformed similar types of physician groups on quality measures 
  • ACOs performed significantly better than comparable physician groups for screening for depression and follow-up plan (53.53% among ACOs vs. 44.42% among comparable MIPS groups,) and controlling high blood pressure (71.21% among ACOs vs. 67.82% among comparable MIPS groups). 
  • ACOs have performed consistently better than comparable physician groups on the patient experience survey measure, Getting Timely Care, Appointments, and Information, for every year that the survey has been fielded since 2019. 

As part of the CY 2026 Physician Fee Schedule Proposed Rule, CMS has proposed a number of changes to the Shared Savings Program, including reducing 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), instead of a maximum of 7 performance years. FMI: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-proposed-rule-cms-1832-p-medicare-shared.