Performance payments for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) reached record highs in 2024, with more than 50 Texas ACOs getting payouts for their role in curbing health care costs.
Of 476 ACOs nationally, 75% earned performance payments totaling $4.1 billion, the Centers for Medicare & Medicaid Services (CMS) announced in a Sept. 29 fact sheet. Texas bested that with 52 of 58 MSSP ACOs (nearly 90%) getting payments.
For the ACOs operating in Texas, 2024 highlights included:
- More than $1.2 billion in gross savings generated;
- $803 million in shared savings paid to 52 ACOs; and
- Payouts ranging from $268,342 to $124.4 million.
“This last year, we’ve seen significant improvement, and along with that improvement, we’ve seen significant revenue stream from the shared savings,” said Thomas Headstream, MD, the Abilene-based chief executive officer of Privia Medical Group – West Texas. He added participating in the MSSP has allowed his practice a “more formal, uniform, and regimented approach to our clinic’s management of chronic health care problems.”
Per CMS’ fact sheet, MSSP ACOs outperformed comparable Merit-Based Incentive Program physician groups on quality measures, with ACOs reporting better quality improvements in patient health in 2024 than in 2023. For example, ACO beneficiaries with adequately controlled high blood pressure increased, and those with poor hemoglobin A1C control decreased.
The 58 ACOs currently participating in Texas include some multi-state ACOs; together, they involve more than 30,000 primary care physicians and nearly 57,000 specialists.
CMS notes what it designates as low-revenue ACOs, typically physician-led ACOs, generated $319 net per capita savings, compared to high-revenue ACOs, which are typically hospital-led, generating $180 net per capita savings. The agency also noted ACOs composed predominantly of primary care clinicians outperformed their counterparts with fewer primary care clinicians, $403 vs. $220 in net per capita savings.
While MSSP participant numbers nationwide have fluctuated between 433 and 561 over the last decade, Texas has remained comparatively more level, with at least 50 ACOs serving the state since 2018, per data collected by the Texas Medical Association staff.
In addition to the potential for shared savings revenue, CMS’ proposed 2026 Medicare Physician Fee Schedule will offer qualifying alternative payment model participants in advanced practice models like MSSP a slightly higher conversion factor, representing a 3.8% increase compared to a 3.3% increase for other physician payments.
Of Texas’ 58 ACOs, 22 are in no-risk contracts, meaning they can’t lose money per MSSP guidelines, but are not eligible for qualifying status as an advanced alternative payment model.
One Texas ACO did owe shared losses of $1.2 million in 2024; nationwide, only 16 ACOs owed shared losses, totaling $20.3 million.
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Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.