MSSP ACOs save Medicare $2.4 billion in 2024 while meeting quality goals

The long-running Medicare Shared Savings Program (MSSP) continues to prove that steadfast investment in value-based care can produce benefits for key stakeholders across the care continuum. 

Building on a solid track record of savings and quality improvements, 2024 was a banner year for the accountable care organizations (ACOs) involved in the program, which cover the care of more than 11.2 million Traditional Medicare beneficiaries.   

The program produced $2.4 billion in Medicare savings relative to benchmarks and returned $4.1 billion in shared savings incentives to participants. 

The 2024 performance year saw the highest share of ACOs receiving performance payments and the highest amount of savings for ACOs and Medicare since the inception of the MSSP, CMS officials said. 

Financial performance highlights include: 

• In 2024, ACOs produced $241 in net per capita savings for Medicare and $643 gross per capita (savings shared by ACOs and Medicare), an increase of $34 and $128 over 2023 levels, respectively. 

• Low-revenue ACOs, which are typically physician-led and often do not include anchor health systems, continued to outperform high-revenue ACOs, producing $316 in net per capital savings compared to $175 net per capita savings for larger entities.   

• ACOs comprised mostly of primary care physicians performed better than those with fewer PCPs, achieving $401 in net per capital savings versus $219. 

• Out of 476 ACOs participating in 2024, only 16 owed shared losses for sub-par performance, totaling $20.3 million.

Participants also steadily improved their quality performance, achieving higher rates of success on critical measures of population health, such as blood pressure and A1C control, when compared to 2023 stats.  

CMS noted that quality performance data is getting easier to analyze and report upon due to adoption of electronic quality reporting options, which are getting more popular year-over-year.  

Notable quality-related achievements include: 

• Among ACOs reporting through the CMS Web Interface, the mean percentage of beneficiaries with controlled high blood pressure increased from 77.80% in 2023 to 79.49% in 2024, which is considered a significant improvement. 

• Among the same group of ACOs, the mean percentage of beneficiaries with poor hemoglobin A1C control declined, indicating improvement in blood sugar management, from 9.84% in 2023 to 9.44% in the latest performance period. 

• When compared to similar physician groups that are not members of ACOs, the MSSP participants outperformed their peers on several measures, including Screening for Depression and Follow-up Plan (53.53% among ACOs versus 44.42% among non-ACOs,) and Controlling High Blood Pressure (71.21% versus 67.82%).  

• ACOs have also performed better than comparable physician groups on patient experience measures, such as Getting Timely Care, Appointments, and Information, for every year since 2019. 

Since the MSSP’s inception in 2012, CMS has shown strong commitment to the MSSP across multiple presidential administrations with drastically different approaches to healthcare policy.   

That commitment is continuing in 2026 with proposed changes designed to accelerate the transition to two-sided risk models by reducing the time an ACO can stay in the upside-only saving track, and adjust definitions for eligible beneficiaries to reduce patient matching and reporting burdens for ACO participants. 

Under the new proposals, ACOs would also be able to apply for hardship exemptions due to suffering an extreme cyberattack. 

However, in line with the Trump Administration’s wholesale abandonment of the principles of equity in healthcare and elsewhere, the proposed rule targets several details related to socioeconomics. 

Notably, the Administration aims to remove the quality measure around completing screenings for social drivers of health, which collects data on beneficiaries experiencing food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety concerns – critical information that has been historically difficult to collect in a standardized manner.  

CMS also plans to remove the health equity adjustment applied to an ACO’s quality score beginning in performance year 2025, asserting that other quality adjustment methodologies have rendered it redundant. The proposal would also rename the potentially defunct adjustment from the “health equity adjustment” to the “population adjustment” in the MSSP regulations for PY 2023 and 2024.  CMS says this change better reflects the purpose of the calculation.  

Nevertheless, with sustained improvements in quality performance and financial savings, it’s clear that CMS remains committed to ensuring the MSSP remains one of its most successful value-based care experiments.    

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].