CMS released the ACO REACH Performance Year 2024 financial and quality results on July 9, 2026. The headline is genuinely good: net savings to CMS of approximately $988.3 million, with gross savings up more than 53% over PY2023.
Then you read one more line in the results, and the story changes completely — in a way that matters enormously for anyone deciding what to do when this model ends, and LEAD begins.
1. The line that reframes everything
About 95% of the net savings came from the benchmark discount. Roughly 5% came from shared savings arrangements.
In plain terms: the overwhelming majority of what CMS saved was not produced by ACOs outperforming their targets. It was produced by CMS setting the targets below expected spending in the first place — the discount applied to the benchmark under the Global option.
The savings were, in large part, structural. CMS collected them by design at the moment the benchmark was set, not by ACOs bending the cost curve past it.
2. What this says about how these models actually generate savings
This is one of the most important and least discussed facts in value-based care. A discount is a guaranteed saving to the payer: take the expected spend, subtract a set percentage, and the difference is banked before anyone changes a single care pathway.
Care transformation is the harder, slower, less certain source. The PY2024 results suggest that in this model, the reliable saving came from the arithmetic and the smaller share came from the operations. That should inform how any risk-bearing organization evaluates the economics it is being offered.
3. The genuinely encouraging part — don’t skip it
Gross savings rose more than 53% between PY2023 and PY2024. That is real, and it suggests ACO performance against forecast improved materially in the model’s later years — which is what you would expect as organizations mature into risk.
The right conclusion is not that ACOs contributed nothing. It is that the model’s net result to CMS was dominated by the discount, while the ACOs’ own contribution was improving from a lower base. Both facts belong in the same sentence.
4. Why this matters urgently for LEAD
If the discount does most of the work, then the discount is the term you negotiate hardest.
ACO REACH concludes at the end of 2026, and the LEAD Model succeeds it beginning January 1, 2027, carrying forward the same basic structure: a Professional option with no discount and up to 50% of savings and losses, and a Global option with an explicit discount and up to 100%.
The PY2024 results are, in effect, a preview of where your economics will be decided. Organizations evaluating the Global option should model the discount with the same seriousness they apply to their care-management plans — because the historical evidence says that term, more than operational performance, determined where the money landed.
5. The question to bring to your own numbers
Ask it directly: in your last performance year, how much of your result came from operational improvement versus benchmark and discount mechanics? Most organizations cannot answer cleanly, which is itself the finding.
If your savings are largely structural, your care-transformation investments have not yet proven themselves, and you should know that before you take on a decade of risk. If they are genuinely operational, that is a demonstrable competitive asset — and it is exactly what a no-rebasing, ten-year model is designed to reward.
Final Thoughts
The PY2024 results deserve to be read carefully rather than celebrated or dismissed. Nearly a billion dollars in net savings is a real policy outcome. And the fact that roughly 95% of it came from the benchmark discount is a real lesson about where the money in these models is actually made.
As someone who has worked inside a REACH-participating network, I would put it this way: care transformation is the work that improves patients’ lives and, over time, your performance. The discount is what determines your economics on day one. Serious organizations get honest about both — especially in the year they choose what comes next.
If you are weighing the Global option under LEAD, the PY2024 REACH results tell you where your economics will actually be decided. At HealtheNomics I help ACOs and IPAs separate structural savings from operational performance in their own numbers — before they commit to a decade of risk.
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