Accountable Care Organizations Deliver $6.5 Billion in Medicare Savings, Boosting Value-Based Care Momentum

Key Clinical Summary

• The Medicare Shared Savings Program (MSSP) achieved $6.5 billion in savings in 2024—the highest since its inception.
• ACOs retained $4.1 billion, while $2.4 billion flowed back to the federal government, according to CMS.
• Quality metrics, including blood pressure, diabetes, and depression management, improved over 2023 levels.

The Centers for Medicare & Medicaid Services (CMS) announced record results for the Medicare Shared Savings Program (MSSP) in 2024, marking its most successful year since the program’s launch over a decade ago. The initiative generated $6.5 billion in savings, underscoring continued momentum in value-based care and cost-efficient, coordinated healthcare delivery nationwide.

Record Savings and Performance Trends

The MSSP—the largest accountable care organization (ACO) program in Medicare—now covers 10.3 million beneficiaries across nearly 480 ACOs. In 2024, 75% of participating ACOs achieved shared savings, totaling $6.5 billion. Of that, $4.1 billion was distributed as performance-based payments, while $2.4 billion returned to Medicare.

By comparison, ACOs saved $5.2 billion in 2023, reflecting a notable 25% year-over-year increase. Leading the nation for the second consecutive year, Citrus County ACO in Central West Florida reported a 22.1% savings rate. Caravan Health ACO, part of CVS-owned Signify Health, achieved the highest net savings at $169.3 million.

At the opposite end, the Alliance for Integrated Care of New York reported a -10.7% savings rate, while Oregon’s Tuality Health Plan Services experienced $12.8 million in losses—though it avoided penalties due to non-participation in downside risk arrangements.

CMS also highlighted that physician-led ACOs continue to outperform hospital-led organizations, with higher savings and stronger outcomes. Those with greater numbers of primary care clinicians showed especially strong performance, reinforcing the link between primary care engagement and cost-effective population health management.

Clinical and Policy Implications for Integrated Care

The MSSP’s record performance signals renewed progress in the shift toward value-based care models. For healthcare executives, the data suggest that physician leadership and robust primary care networks remain central to ACO success.

The findings also come amid regulatory adjustments aimed at broadening participation. The Biden administration’s recent reforms—such as upfront payments and advanced savings access—seek to attract new entrants, especially smaller providers wary of financial risk. Meanwhile, a pending rule proposed in July would shorten the period ACOs can operate without downside risk and streamline reporting burdens.

Despite the positive trajectory, growth in participation has slowed. The number of MSSP ACOs has declined from a peak of 561 in 2018 to 476 in 2024, reflecting persistent provider hesitancy.

Conclusion

The 2024 MSSP results underscore the growing potential of accountable care models to improve outcomes and reduce Medicare costs. Sustaining this momentum will depend on continued regulatory refinement, greater provider engagement, and strategic emphasis on physician-led, primary care–centered models.

Reference

Pifer R. Medicare saved record $2.4B from largest accountable care program last year. Healthcare Dive. Published September 3, 2025. Accessed November 4, 2025. https://www.healthcaredive.com/news/medicare-shared-savings-2024-cms-accountable-care/759036/