How well is accountable care performing?

A national scorecard of accountable-care delivery — shared savings, quality reporting, downside accountability and loss avoidance across the Medicare Shared Savings Program (MSSP), REACH and GRP ACOs — showing where accountable care is succeeding and where it falls short, plus the multi-year trajectory.

3 succeeding 1 gap across 4 accountable-care signals

3 of 4 accountable-care signals are succeeding; 1 show a gap. MSSP ACOs delivered record results in 2024 — 75.4% earned shared savings, quality reporting is near-universal, and Medicare kept $2,414,815,340 in net savings — but roughly a third of ACOs still bear no downside risk.

Financial and quality signals from fact_aco_performance_mssp (2024 performance year — the latest of 2013-2024); scale from dim_aco (1,293 ACOs) and fact_provider_aco. The performance scorecard is framed on the 476-ACO MSSP reporting cohort (REACH/GRP carry no shared-savings dual).
Accountable Care Orgs
1,293
MSSP 1,052 · REACH 132 · GRP 109
Assigned Beneficiaries
10,326,340
Covered by MSSP ACOs (2024)
Participating Providers
491,707
NPIs on an ACO participant roster
Net Savings to Medicare
$2,414,815,340
MSSP, 2024 performance year
Shared Savings
75.4%
359 of 476 reporting ACOs
Broadly earning savings
1,293 ACOs operate nationally (MSSP 1,052, REACH 132, GRP 109); 476 MSSP ACOs reported 2024 financial and quality results — the report-card denominator (REACH/GRP carry no shared-savings dual).
Share of reporting MSSP ACOs that earned shared savings in 2024 (net earn_save_loss > 0) — the core accountable-care success signal. Only 16 owed losses.
Quality Reporting
98.9%
471 of 476 reporting ACOs
Near-universal reporting
Share of reporting ACOs that met the MSSP quality-reporting requirements in 2024 (met_ssp_quality_reporting_requirements). Average quality score: 81.9%.
Downside Accountability
67.0%
319 of 476 reporting ACOs
Risk-taking gap
Share of reporting ACOs in a two-sided risk model (accountable for losses, not just upside — risk_model). Bearing downside risk is the mark of a mature accountable-care arrangement; a third still take no downside risk.
Loss Avoidance
96.6%
460 of 476 reporting ACOs
Losses rare
Share of reporting ACOs that did NOT owe losses in 2024 — only 16 of 476 owed money back to Medicare. Accountable care rarely costs the program.
Where accountable care is succeeding
  • Shared savings: 75.4% of reporting MSSP ACOs earned shared savings in 2024 — accountable care is paying off financially.
  • Quality reporting: 98.9% of reporting ACOs met the MSSP quality-reporting requirements.
  • Loss avoidance: 96.6% of reporting ACOs owed no losses — downside outcomes are rare.
Accountable-care signals meeting the succeeding threshold
Where accountable care falls short
  • Downside accountability: only 67.0% of reporting ACOs bear two-sided (downside) risk — a third stay upside-only.
Accountable-care signals below the succeeding threshold — the improvement gaps
The trajectory of accountable care (2014–2024)
Net savings to Medicare and the number of ACOs earning shared savings, by MSSP performance year
Top ACOs by shared savings earned (2024)
The accountable-care organizations succeeding most — select an ACO to open its detail page.
# ACO Shared savings earned Quality score Assigned beneficiaries
1 Caravan Collaborative Pathways A4604 $127,143,802 84.3% 328,733
2 Health Connect Partners, LLC A2342 $122,660,765 84.3% 154,409
3 PBACO Holding, LLC A1001 $107,895,330 77.0% 116,175
4 Sound Physicians Long Term Care Management, LLC A5220 $83,779,293 60.7% 12,460
5 Elite Patient Care, LLC A5069 $81,130,886 77.0% 16,361
6 Baylor Scott & White Quality Alliance A2542 $76,821,106 94.2% 115,862
7 Mercy Health ACO, LLC A2616 $75,912,603 88.2% 113,505
8 Mercy Health Select, LLC A1215 $62,760,283 93.2% 106,242
9 Privia Quality Network, LLC A2057 $56,874,293 89.7% 61,313
10 Advocate Health Enterprise ACO A1033 $50,643,583 85.4% 134,269
11 Houston Methodist Coordinated Care A3473 $50,392,985 95.6% 49,360
12 Stratum Med ACO A4527 $50,214,333 85.0% 94,272
13 Steward National Care Network, Inc. A3834 $49,919,779 77.0% 73,142
14 Delaware Valley ACO A2024 $49,396,726 83.6% 74,756
15 LTC ACO, LLC A2973 $48,735,873 77.2% 10,209
Care signals: 3/4 succeeding Shared Savings Quality Reporting Downside Accountability Loss Avoidance
Program Split
ACOs by program — MSSP vs REACH vs GRP
Total ACOs: 1,293 MSSP: 1,052 REACH: 132 GRP: 109

All accountable-care organizations in dim_aco by program: the Medicare Shared Savings Program (MSSP) dominates, with the ACO REACH model and GRP demonstrations trailing. Only MSSP carries the shared-savings and quality reporting used in the scorecard above.

Savings & Losses Distribution (2024)
Financial outcome and the magnitude of earned shared savings
Earned savings: 359 Owed losses: 16 Neutral: 101

Reporting MSSP ACOs in the 2024 performance year by financial outcome (earn_save_loss sign), and the dollar magnitude of the 359 that earned shared savings. Neutral ACOs neither earned savings nor owed losses. Only 16 owed money back to Medicare.

Quality-Score Distribution (2024)
How reporting ACOs score on quality
Scored ACOs: 476

Distribution of MSSP quality scores for the 2024 performance year, over the 476 scored ACOs. CMS reports quality on mixed scales across years (0-1 and 0-100), normalized to 0-100 here; scores cluster in the 80s-90s.

Participation / Roster
The MSSP ACOs earning the most — select an ACO to open its detail page
# ACO Program Shared savings earned Quality score Assigned beneficiaries
1 Caravan Collaborative Pathways A4604 MSSP $127,143,802 84.3% 328,733
2 Health Connect Partners, LLC A2342 MSSP $122,660,765 84.3% 154,409
3 PBACO Holding, LLC A1001 MSSP $107,895,330 77.0% 116,175
4 Sound Physicians Long Term Care Management, LLC A5220 MSSP $83,779,293 60.7% 12,460
5 Elite Patient Care, LLC A5069 MSSP $81,130,886 77.0% 16,361
6 Baylor Scott & White Quality Alliance A2542 MSSP $76,821,106 94.2% 115,862
7 Mercy Health ACO, LLC A2616 MSSP $75,912,603 88.2% 113,505
8 Mercy Health Select, LLC A1215 MSSP $62,760,283 93.2% 106,242
9 Privia Quality Network, LLC A2057 MSSP $56,874,293 89.7% 61,313
10 Advocate Health Enterprise ACO A1033 MSSP $50,643,583 85.4% 134,269
11 Houston Methodist Coordinated Care A3473 MSSP $50,392,985 95.6% 49,360
12 Stratum Med ACO A4527 MSSP $50,214,333 85.0% 94,272
13 Steward National Care Network, Inc. A3834 MSSP $49,919,779 77.0% 73,142
14 Delaware Valley ACO A2024 MSSP $49,396,726 83.6% 74,756
15 LTC ACO, LLC A2973 MSSP $48,735,873 77.2% 10,209
MSSP ACOs: 1,052 Total ACOs: 1,293

The MSSP ACOs earning the most shared savings, ranked — select an ACO to open its detail page. Participant-level rosters (the provider/organization members) are published only for MSSP ACOs (1,052 of 1,293); REACH and GRP carry no participant list, so this savings-ranked roster is MSSP-only (D-A-1).

Year-over-Year Performance
The year-by-year MSSP trajectory table
Year ACOs Earners Net to Medicare
2013 220 0 —
2014 333 86 $464,961,319
2015 392 119 $745,217,564
2016 432 134 $736,897,153
2017 472 159 $883,429,709
2018 548 205 $595,730,239
2019 541 264 $778,710,071
2020 513 345 $2,090,643,920
2021 475 274 $1,685,049,998
2022 482 303 $1,641,115,122
2023 453 313 $1,916,975,866
2024 476 359 $2,414,815,340

Year-by-year MSSP accountable-care trajectory (2013–latest): reporting ACOs, the number earning shared savings, and the net savings kept by Medicare (generated minus shared savings paid out). The first year carries no save/loss data, so net-to-Medicare is unavailable there.