The Centers for Medicare and Medicaid Services (CMS) recently reached a significant milestone in its value-based care initiative: more than half of fee-for-service Medicare enrollees are now part of accountable care arrangements. This achievement reflects substantial progress toward CMS’s ambitious 2030 goal of enrolling all fee-for-service beneficiaries in accountable care programs.
As of 2025, accountable care participation has risen 4.3% to encompass 14.8 million individuals—a 53.4% share of fee-for-service beneficiaries. This represents the largest annual increase since CMS began tracking these metrics. The data highlights CMS’s commitment to transforming Medicare into a value-based system, focused on cost management and improved health outcomes.
Accountable Care Organizations: Progress and Challenges
Medicare Shared Savings Program (MSSP)
The Medicare Shared Savings Program (MSSP), a cornerstone of CMS’s accountable care efforts, has shown notable growth. In 2025, MSSP participation rose 3.7%, bringing 11.2 million beneficiaries under its umbrella. This program currently involves:
- 476 ACOs
- 656,000 providers
MSSP ACOs reported record-breaking savings in 2023, underscoring the program’s success in reducing costs while improving care quality. In November, CMS introduced a prepaid shared savings option, allowing participants to make upfront investments aimed at enhancing outcomes and cutting costs further.
ACO REACH: A Mixed Bag
The ACO Realizing Equity, Access, and Community Health (REACH) model, designed to advance equity and access, experienced a decline in participation. The number of beneficiaries dropped by 3.8% to 2.5 million in 2025, with the number of participating ACOs falling from 122 to 103.
Despite evidence of savings, the future of ACO REACH remains uncertain as CMS has not committed to extending it beyond its scheduled sunset in 2026. This underscores the challenges in maintaining momentum across all accountable care models.
New Models Supporting the Vision
CMS continues to innovate with models like the ACO Primary Care Flex Model (PC Flex) and the Kidney Care Choices Model:
- PC Flex: Launched in 2025, this initiative emphasizes primary care payment within MSSP, covering approximately 350,000 beneficiaries across 24 ACOs.
- Kidney Care Choices: With 8,430 providers, this model supports 240,000 enrollees, focusing on improving care for patients with kidney disease.
These models reflect CMS’s ongoing efforts to refine value-based care strategies and address the diverse needs of Medicare beneficiaries.
Opportunities and Barriers to Success
The Path Forward for Value-Based Care
CMS’s progress demonstrates the power of value-based care in promoting innovation and improving health outcomes. As Aisha Pittman, senior vice president of government affairs for the National Association of ACOs, noted, empowering providers to manage costs and focus on outcomes drives innovation and ensures high-quality care.
However, significant work remains to achieve the 2030 goal. Sustained commitment from federal leadership, providers, and policymakers is essential. Future advancements will depend on:
- Increased Participation: Expanding models like MSSP and PC Flex to encompass more beneficiaries.
- Equity-Focused Innovations: Strengthening initiatives like ACO REACH to address health disparities.
- Policy and Financial Support: Ensuring Congress extends bonus payments for providers transitioning to value-based care.
Challenges to Overcome
- Program Declines: The drop in ACO REACH participation highlights the difficulty in sustaining certain models.
- Funding and Incentives: Balancing costs with provider incentives is a critical challenge for maintaining engagement.
- Leadership Transition: Political shifts, such as the transition between administrations, could impact long-term value-based care goals.
Implications for Healthcare Providers
For healthcare organizations and providers, these developments present opportunities to align with Medicare’s value-based care vision. Participation in programs like MSSP and PC Flex can lead to:
- Improved Outcomes: Focusing on preventive care and chronic disease management.
- Cost Savings: Leveraging shared savings opportunities through efficient care delivery.
- Enhanced Reputation: Demonstrating commitment to innovation and quality improvement.
Looking Ahead: A Shared Vision for 2030
As Medicare advances toward its 2030 goal, the healthcare landscape is poised for transformative change. CMS’s efforts highlight the potential of value-based care to deliver cost-effective, equitable, and high-quality healthcare for millions of Americans.
While challenges remain, the progress achieved so far demonstrates that this vision is achievable. By fostering collaboration among policymakers, providers, and healthcare organizations, Medicare can continue to build a system that prioritizes value over volume—one that ultimately improves the lives of patients nationwide.
