WASHINGTON, D.C. — The U.S. Centers for Medicare & Medicaid Services said accountable care is reaching a record number of older Americans in 2026, with more than 14 million Medicare beneficiaries now receiving coordinated, whole-person care through Accountable Care Organizations, a model the Trump administration is championing as a way to improve outcomes while cutting waste.
As of January, an estimated 14.3 million people with Medicare are enrolled in care coordinated by ACOs, up from 13.7 million a year earlier — a 4.4 percent increase, CMS said. The total includes beneficiaries served by Medicare Shared Savings Program ACOs and organizations participating in CMS Innovation Center models focused on total cost of care, advanced primary care, and specialty services.
ACOs are networks of doctors, hospitals, and other providers who agree to work together to deliver coordinated, high-quality care while being held financially accountable for both spending and patient outcomes. CMS officials said the approach reduces fragmented care, helps patients avoid unnecessary emergency visits and duplicative tests, and strengthens the long-term outlook of the Medicare Trust Funds.
The agency said accountable care models are also producing substantial savings. In Performance Year 2024, the most recently finalized year, Shared Savings Program ACOs generated $4.1 billion in shared savings and reduced Medicare spending by $2.5 billion overall.
Participation continues to deepen as organizations take on greater financial risk. In 2026, 82.8 percent of Shared Savings Program ACOs are operating in higher-risk tracks that qualify as Advanced Alternative Payment Models, the highest share since the program began in 2012. CMS also finalized changes in the 2026 physician fee schedule aimed at accelerating adoption of two-sided risk, in which ACOs can share in savings but are also responsible for losses if costs rise.
CMS approved 134 applications for the Shared Savings Program for the 2026 performance year, including 72 new ACOs. That brings total participation to 511 ACOs, up from 476 in 2025. Those organizations will serve a record 12.6 million people with traditional Medicare, a 12.3 percent increase from the prior year, supported by more than 700,000 health care providers.
Other accountable care models are also expanding. The ACO REACH model includes 74 organizations serving an estimated 1.7 million Medicare beneficiaries, with heavy participation from federally qualified health centers, rural health clinics, and critical access hospitals. The Kidney Care Choices model now covers 237,000 people with chronic kidney disease and end-stage renal disease, while the ACO Primary Care Flex model is testing new payment approaches for primary care across 23 ACOs.
CMS officials said additional changes are on the horizon, including the Long-term Enhanced ACO Design model, known as LEAD, set to launch in 2027. The model is designed to attract smaller, independent, and rural practices and to improve care coordination for high-needs patients, including those dually eligible for Medicare and Medicaid and those who are homebound.
Together, the agency said, ACOs and related value-based payment models represent a central pillar of its strategy to deliver better health outcomes at lower cost for Medicare beneficiaries, while preserving the program for future generations.
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