Designing accountable care: Lessons from CMS Accountable Care Organizations

In July 2022, the Centers for Medicare and Medicaid Services (CMS) announced plans to expand the scale and scope of the accountable care organization (ACO) program. To inform this effort, we have synthesized evidence on CMS ACOs to identify factors that have facilitated or hindered success. ACOs are groups of physicians, hospitals, and other providers that coordinate care for patients while being held accountable for the quality and cost of care through financial and nonfinancial levers, including payments and performance measurement. CMS and the Center for Medicare and Medicaid Innovation have tested several ACO models. While payment approaches differ, generally ACOs receive a combination of traditional fee-for-service (FFS) and prospective or capitated payments, also known as value-based payments. ACOs can share in any savings with Medicare if they improve quality.