2026 Strategies for Growth in Accountable Care Organizations

Accountable Care Organizations face major changes in 2026 as CMS implements new financial methodologies and program requirements. Organizations pursuing growth must adapt to tighter risk adjustment caps, updated benchmarking approaches, and increased quality emphasis. CMS aims to have 100% of traditional Medicare beneficiaries in accountable care relationships by 2030, creating opportunities for expansion for prepared organizations.

Transition to Two-Sided Risk Models

ACOs operating under one-sided risk arrangements face pressure to accept downside risk. The MSSP now limits initial one-sided participation to five years for new agreement periods starting in 2027. Organizations must evaluate readiness for enhanced tracks where savings potential increases alongside loss exposure. ACOs with mature care management programs and proven cost control capabilities are better positioned for this transition.

Strengthen Primary Care Networks

Strong primary care foundations drive ACO performance across all models. Organizations expand by recruiting primary care physicians in underserved markets and supporting existing providers with care coordination infrastructure. Primary care attribution determines beneficiary assignment, making physician relationships critical for population growth.

Invest in Care Coordination Infrastructure

Growing Accountable Care Organizations need software that connects hospitals, specialists, rehabilitation facilities, and community services. The software pulls patient data from all these places. Care teams with complete patient information coordinate better than those working from incomplete records.

Optimize Quality Performance Strategies

Quality scores directly affect shared savings percentages and track eligibility. Organizations prioritize measures yielding maximum impact, including patient experience surveys, preventive service delivery, and chronic disease control metrics. Real-time quality tracking allows intervention during patient encounters rather than retrospective gap closure.

Critical Quality Domains

• Patient and caregiver experience measures
• Care coordination and safety measures
• Preventive screenings and vaccines
• Chronic disease management for high-risk patients

Plan for Model Uncertainty Beyond 2026

ACO REACH ends in 2026 unless CMS extends it. Organizations currently in REACH should look at joining MSSP or other programs. Having contracts with multiple value-based programs means organizations stay viable even when one program ends or changes.

Prepare CMS LEAD Model Transition

The CMS LEAD Model represents CMS’s next phase of accountable care following the scheduled end of ACO REACH after 2026. While detailed financial parameters are still forthcoming, CMS has signaled that LEAD will apply tighter guardrails around risk adjustment, benchmarking stability, and coding intensity to support long-term sustainability. Organizations planning to transition into LEAD must evaluate how these controls may affect benchmark revenue, beneficiary growth, and performance strategy as CMS standardizes expectations across advanced risk models.

Key CMS LEAD Transition Considerations

• Stronger limits on risk score growth tied to historical baselines
• Refined coding intensity controls, with adjustments for high-need populations
• Risk adjustment constraints for newly aligned beneficiaries
• Elimination of growth-based exemptions as CMS enforces consistent scale and accountability

Takeaway

Persivia helps Accountable Care Organizations manage transitions between programs. The platforms pull data from hospitals, clinics, and other care locations. Organizations see their quality scores, which patients are assigned to them, and projected savings or losses under MSSP, REACH, and commercial ACO contracts. Organizations using Persivia access real-time data supporting decisions about risk model selection, provider network development, and quality improvement priorities.