For many independent practices, joining an accountable care organization (ACO) felt less like a choice than a hedge. Value-based care was expanding, payers were nudging practices toward it, and competitors were signing on. 

Several years later, many groups are left wondering: “Where are the shared savings, and is our practice the problem or the ACO?”

In Performance Year 2024, 75% of the 476 ACOs in the Medicare Shared Savings Program (MSSP) earned performance payments — the highest share since the program began in 2012 — and only 16 ACOs owed losses.¹ When most participants are now earning something and you are earning nothing, it’s time to investigate.

Your best way to do so is determine whether a given ACO’s structure, attribution model, specialty mix, data capabilities, payer contracts, governance, and distribution methodology fit your patient population and your business goals. A capable ACO should help you understand your attributed population, improve quality and cost performance, manage risk, and share meaningfully in any savings generated. When those pieces are missing, changing ACOs won’t fix anything until you’ve identified what’s actually failing today.