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Medicare ACO participation increases in 2023


13 million Medicare patients served by ACOs

The number of Accountable Care Organizations serving Medicare patients is increasing in 2023, according to data from CMS. There are now 456 ACOs in the Medicare Shared Savings Program, and another 132 in the ACO Realizing Equity, Access, and Community Health (REACH) model. Combined, they serve 13 million Medicare patients.

“We expect 2023 to be a turning point for ACOs and growth in participation to really accelerate in 2024 thanks to CMS leadership,” said Clif Gaus, president and CEO, National Association of ACOs (NAACOS.) “The interest in high-risk models like ACO REACH should be a signal that CMS needs to include more high-risk options in the Shared Savings Program with many of the features of REACH.”

CMS changed the Shared Savings Program last year to encourage providers to join ACOs, including

giving up-front investment money that’s paid back through shared savings, a slower path to financial risk, more realistic policies around financial spending targets, and others. The REACH Model saw updates that increase provider governance, place greater emphasis on health equity, and giving additional oversight and patient protections.

In 2021, CMS set a goal to have all traditional Medicare beneficiaries in a care relationship with a provider who is accountable for their quality and total cost of care by 2030. NAACOS said it strongly supports that goal, but participation in the Shared Savings Program peaked in 2018 with 561 ACOs and has fallen since new CMS rules that force ACOs into financial risk faster took effect.

Other important numbers from 2023 participation data:

  • 10.9 million beneficiaries are cared for by MSSP ACOs and 2.1 million cared for by REACH ACOs
  • 67% of Shared Savings Program ACOs are in two-sided risk and 33% are in one-sided risk
  • Nearly 704,000 physicians and other non-physicians are in ACOs
  • More than 1,450 hospitals are in ACOs
  • There are 24 REACH ACOs in the professional risk track and 108 in the global risk track
  • There are 105 Standard, 13 New Entrant, and 14 High Needs REACH ACOs
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Jennifer N. Lee, MD, FAAFP
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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
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© National Institute for Occupational Safety and Health