Healthcare Insights
Top 25 ACOs by gross savings
The Patient Protection and Affordable Care Act (ACA) created accountable care organizations (ACOs) to accomplish two goals: 1) deliver high-quality, coordinated care to specific patient bases and 2) reduce unnecessary expenses—while enabling ACOs to share in those savings via reimbursement through the Medicare Shared Savings Program (MSSP).
An ACO’s gross savings/losses is a calculation of its total benchmark expenditures minus total aligned beneficiary expenditures. This metric shows the total amount saved or lost by the organization and represents the total savings (or losses) to be split between the ACO and the Centers for Medicare and Medicaid (CMS).
Below, we used our ConnectedCareView product and the MSSP to rank the top 25 ACOs in the U.S. according to their gross generated savings/losses.
| Rank | Definitive ID | ACO name | State | Gross generated savings | Explore dataset |
|---|---|---|---|---|---|
| 1 | 1002286 | Caravan Collaborative Pathways (AKA Caravan Health ACO 22 LLC) | TX | $ 169,269,888 | Explore |
| 2 | 583280 | Health Connect Partners | WA | $ 166,348,992 | Explore |
| 3 | 552157 | Palm Beach Accountable Care Organization | FL | $ 146,034,112 | Explore |
| 4 | 1059988 | Sound Physicians Long Term Care Management LLC | WA | $ 113,973,744 | Explore |
| 5 | 1044890 | Elite Patient Care LLC | TX | $ 110,336,616 | Explore |
| 6 | 800687 | Baylor Quality Health Care Alliance LLC (FKA Baylor Scott & White Quality Alliance) | TX | $ 103,414,856 | Explore |
| 7 | 800734 | Mercy Health ACO | MO | $ 101,952,776 | Explore |
| 8 | 552206 | Mercy Health Select ACO | OH | $84,572,320 | Explore |
| 9 | 583229 | Privia Quality Network LLC | VA | $77,159,488 | Explore |
| 10 | 903971 | Houston Methodist Coordinated Care | TX | $68,328,664 | Explore |
| 11 | 552160 | Advocate Physician Partners Accountable Care | IL | $67,587,504 | Explore |
| 12 | 963485 | Steward National Care Network Inc | MA | $67,397,088 | Explore |
| 13 | 583199 | Delaware Valley ACO | PA | $66,952,920 | Explore |
| 14 | 1002285 | Caravan Health ACO 20 LLC | MO | $66,753,728 | Explore |
| 15 | 846881 | LTC ACO (FKA Genesis HealthCare ACO) | PA | $66,236,760 | Explore |
| 16 | 1010015 | CA MSSP 2020 Enhanced (AKA Aledade Accountable Care 60) | MD | $63,275,056 | Explore |
| 17 | 904025 | Piedmont Clinic ACO | GA | $61,690,816 | Explore |
| 18 | 1010047 | Sentara Accountable Care Organization LLC | VA | $58,287,848 | Explore |
| 19 | 583268 | The Accountable Care Organization | VA | $57,771,840 | Explore |
| 20 | 1002254 | California Clinical Partners ACO LLC | FL | $57,243,232 | Explore |
| 21 | 846874 | CHRISTUS Health Quality Care Alliance (AKA CPG Quality Care Alliance) | TX | $57,023,312 | Explore |
| 22 | 903925 | Aledade Accountable Care 16 (Closed) | MD | $55,132,716 | Explore |
| 23 | 800813 | USMM Accountable Care Partners | MI | $53,525,772 | Explore |
| 24 | 1002270 | NC MSSP Legacy Enhanced (AKA Aledade Duwamish ACO LLC) | MD | $51,921,820 | Explore |
| 25 | 1002262 | Mass General Brigham ACO LLC | MA | $49,536,996 | Explore |
Fig 1. Analysis using data from the Definitive Healthcare ConnectedCareView product. Data sourced from the Medicare Shared Savings Program (MSSP). Current full year of data available is 2024. Data accessed February 2026.
Which ACOs generated the greatest savings in 2024?
At the top of our list is Caravan Collaborative Pathways, located in Texas. It generated about $169.3 million in gross savings in 2024, narrowly edging out Health Connect Partners, which placed second. Health Connect Partners generated about $166.3 million during this time period.
Palm Beach Accountable Care Organization comes in third place and generated about $146 million in gross savings in 2024.
The gap between ranks one and five is notable but not extreme; the top five ACOs all generated more than $110M in savings.
Geographically, Texas stands out as the most represented state on our list, with five ACOs in the top 25. Read our Healthcare Insight on the top 20 ACOs in Texas for more insights.
Caravan Collaborative Pathways also appears on our list of the top 25 ACOs by patient population size, where it ranked 19.
Why data on gross savings matter to value-based care strategies
Information on the ACOs that generate the greatest gross savings matters because it provides tangible evidence of how well organizations are delivering on the core aims of value-based care: better outcomes at lower costs.
In value-based models like the Medicare Shared Savings Program, providers earn shared savings only if they deliver high-quality care while reducing total cost of care against established benchmarks. Tracking gross savings shows whether an ACO’s care management, preventive focus, and coordination are actually improving patient outcomes and addressing chronic illnesses while saving money. The mode has proven to be a success. According to the American Association of Family Physicians, 2024 achieved the highest rates of shared savings since the inception of the MSSP. Participating ACOs generated $2.4 billion in savings for Medicare, the highest savings amount in the program’s history.
From a strategic perspective, savings outcomes matter not only for internal improvement but also for market positioning and partnerships. High gross savings signal to payors, partners, and investors that an ACO has operational maturity and financial discipline, making it a stronger candidate for value-based contracts, and risk sharing and population health initiatives.
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Healthcare Insights are developed with data from the Definitive Healthcare product portfolio and from CMS. Want even more insights? See how many ACOs are in each state in the U.S. or start a free trial today and get access to the latest intelligence on hospitals, physician groups, ACOs, and other providers.
