Number of Medicare ACOs stays flat, but financial risk-taking increases

The total number of Medicare accountable care organizations (ACOs) operating in 2020 changed little from 2019, but significantly more are taking on financial risk.

The Medicare Shared Savings Program (MSSP) - the main Medicare ACO program - has 517 ACOs operating in 2020, which is one fewer than 2019's total, according to Medicare data. The number also is down from a high of 561 in 2018, before the Trump administration changed the rules to require more financial risk from participants.

Senior Trump administration officials repeatedly said they do not mind if the program shrinks as long as more ACOs move from the risk-free upside-only track into risk categories, which officials said are more likely to drive providers to change their approaches to care.

Subsequently, participation in the no-risk track has trended downward:

* 91% of all MSSP ACOs in 2017

* 82% in 2018

* 26% in 2020 I