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.
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).
Check out our list of the top 25 ACOs in the U.S. according to their gross generated savings/losses.
Top ACOs with the highest generated savings in 2021
| Rank | ACO Name | State | Definitive ID | Patient Population | Earned Shared Savings Payments/Losses | (Gross) Generated Savings/Losses |
| 1 | Baylor Quality Health Care Alliance LLC (FKA Baylor Scott & White Quality Alliance) | TX | 800687 | 129,866 | $47,128,684 | $96,365,360 |
| 2 | Advocate Physician Partners Accountable Care | IL | 552160 | 113,033 | $37,595,221 | $77,622,055 |
| 3 | Palm Beach Accountable Care Organization | FL | 552157 | 80,864 | $54,320,998 | $72,427,998 |
| 4 | Steward National Care Network Inc | MA | 963485 | 161,364 | $51,533,448 | $68,711,265 |
| 5 | Health Connect Partners | WA | 583280 | 115,202 | $26,113,602 | $67,395,249 |
| 6 | Partners HealthCare Accountable Care Organization LLC | MA | 1002262 | 126,420 | $46,711,743 | $64,296,497 |
| 7 | Mercy Health ACO | MO | 800734 | 134,096 | $29,603,158 | $60,919,682 |
| 8 | Privia Quality Network LLC | VA | 583229 | 70,483 | $42,266,717 | $58,178,130 |
| 9 | Millennium Accountable Care Organization | FL | 802274 | 66,651 | $40,667,398 | $55,435,857 |
| 10 | Silver State ACO | NV | 583251 | 52,296 | $32,725,201 | $44,185,926 |
| 11 | Caravan Health ACO 22 LLC | MO | 1002286 | 96,889 | $15,432,521 | $39,829,000 |
| 12 | Piedmont Clinic | GA | 904025 | 70,348 | $15,015,308 | $38,686,785 |
| 13 | Keystone ACO | PA | 574708 | 74,887 | $18,489,695 | $38,175,281 |
| 14 | Mercy Health Select ACO | OH | 552206 | 67,576 | $28,471,325 | $38,140,550 |
| 15 | Somos ACO | NY | 1002291 | 15,829 | $18,313,628 | $37,811,759 |
| 16 | NewYork Quality Care | NY | 800766 | 34,239 | $18,194,513 | $37,565,826 |
| 17 | Dignity Health Care Network LLC | CA | 1010027 | 70,308 | $15,005,537 | $37,513,843 |
| 18 | NorthShore Physician Associates Value Based Care LLC | IL | 963492 | 49,021 | $13,089,596 | $33,296,270 |
| 19 | Mayo Clinic Community ACO LLC | MN | 1002284 | 57,696 | $12,651,109 | $32,335,104 |
| 20 | CHRISTUS Health Quality Care Alliance (AKA CPG Quality Care Alliance) | TX | 846874 | 63,512 | $12,218,627 | $31,534,424 |
| 21 | Ochsner Accountable Care Network | LA | 574724 | 31,239 | $22,355,580 | $30,377,009 |
| 22 | Memorial Hermann Accountable Care Organization | TX | 552219 | 43,213 | $11,491,733 | $29,560,729 |
| 23 | Trinity Health Integrated Care | MI | 904056 | 72,956 | $21,262,409 | $29,266,697 |
| 24 | WellMed Texas Medicare ACO LLC | TX | 1010058 | 27,330 | $14,475,006 | $28,950,011 |
| 25 | New York Medical Partners ACO | NY | 904004 | 49,278 | $11,041,383 | $28,496,135 |
Fig 1. Data is from the Definitive Healthcare ConnectedCareView product. Data is sourced from Definitive Healthcare’s proprietary research and CMS Physicians Compare. Data accurate as of July 2022.
Which ACOs generated the greatest savings in 2021?
Definitive Healthcare data show that Baylor Quality Health Care Alliance LLC generated $96.3 million in Medicare savings in 2021, making them number one on our list. They’re also the third-largest ACO by patient population and earned shared savings payments (their take-home share of gross savings).
Advocate Physician Partners Accountable Care generated $77.6 million in gross Medicare savings in 2021, putting them in second with a 19% drop from the top position.
Taking third is the Palm Beach ACO, with $72.4 million in gross savings. They topped another list, however, with $54.3 million in earned shared savings payments.
The largest ACO by patient population, Steward National Care Network Inc, follows in fourth with $68.7 million in gross savings.
How are shared savings payments calculated?
Earned shared savings payments are the ACO’s share of savings to be paid by CMS. Losses can also be represented by this metric—though not seen in this data, negative values indicate an amount owed by the ACO to CMS.
Payments are determined based on several factors: the ACO’s risk arrangement (80% or 100% risk), the ACO’s elected savings/losses cap percentage (between 5-15%) and any reductions due to sequestration.
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