More than half of fee-for-service Medicare enrollees are now in accountable care arrangements, putting the Centers for Medicare and Medicaid Services past midway toward its 2030 goal, according to data the agency released Wednesday.
Accountable care participation rose 4.3% to 14.8 million people from 2024 to 2025, the largest annual increase since CMS started tracking these numbers. That amounts to 53.4% of fee-for-service beneficiaries, according to the agency.
Related: ACO REACH savings report invigorates calls for extension
The CMS report illustrates the progress the agency has made promoting value-based care in traditional Medicare since announcing in 2021 that it wanted all fee-for-service enrollees in accountable care arrangements by 2030. It also shows how much is left to do to meet that target, and consummating the endeavor would require President-elect Donald Trump's administration to pick up where President Joe Biden's team leaves off.
“This progress demonstrates that when providers are empowered to manage costs and focus on outcomes, they can achieve high-quality outcomes and drive innovation,” Aisha Pittman, senior vice president of government affairs for the National Association of ACOs, said in a news release.
Tweaks to existing accountable care organizations and the creation of models such as the ACO Primary Care Flex Model support the 2030 goal, but regression in one high-profile model highlights the ongoing challenges. Congress also must decide how to handle bonus payments for providers transitioning into value-based care.
The CMS report covers the permanent Medicare Shared Savings Program and models from the Center for Medicare and Medicaid Innovation such as ACO Realizing Equity, Access and Community Health, or ACO REACH.
Participation in the Shared Savings Program rose 3.7% to 11.2 million enrollees. The Shared Savings Program encompasses 476 ACOs and 656,000 providers. Shared Savings Program ACOs generated record savings in 2023, CMS announced in October.
CMS finalized a prepaid shared savings option for the Share Savings Program in November, which participants say will enable them to make upfront investments that will reduce costs and improve quality.
“We are thrilled to see continued strong commitment to advancing accountable care, proven out by the increased participation across Medicare ACO programs,” Mara McDermott, CEO of the value-based care trade group Accountable for Health, wrote in an email.
ACO REACH went the other direction. This year, 2.5 million beneficiaries participated, a 3.8% decline, as the number of ACOs dwindled from 122 to 103. The model’s future is uncertain because CMS has not said whether it will extend ACO REACH past 2026, when it's scheduled to sunset, despite evidence of savings.
The Kidney Care Choices Model includes 8,430 providers and organizations and is expected to touch 240,000 enrollees this year.
The ACO Primary Care Flex Model, also known as PC Flex, covers about 350,000 beneficiaries under 24 ACOs. The initiative launched Jan. 1 and focuses on primary care payment within the Shared Savings Program.