Top 10 Accountable Care Organizations by Shared Savings in 2019

Accountable care organizations in the Medicare Shared Savings Program had a record year in 2019; here are the ACOs that earned the highest bonuses.

Accountable care organizations (ACOs) in the Medicare Shared Savings Program collectively saved $2.6 billion in 2019, netting Medicare $1.19 billion, according to the latest program performance data.

The figure marks the largest annual savings for the program to date and also the third consecutive year for net program savings, Administrator Seema Verma highlighted in a recent Health Affairs blog post sharing the data.

In total, 541 ACOs participated in the Shared Savings Program during the 2019 performance period, including some organizations that elected to join new program tracks halfway through the period under Pathways to Success.

ACOs electing to participate under a Pathways to Success track saved more than their counterparts in “legacy” tracks, showing net per-beneficiary savings of $169 per beneficiary compared to $106 per beneficiary for legacy track ACOs, Verma reported.

Additionally, ACOs generally saved more if the organization assumed downside financial risk (in both Pathways to Success and legacy tracks), had more experience in the program, and were low-revenue (e.g., physician-led).

In the following list, RevCycleIntelligence breaks down the individual ACOs that earned the most shared savings payments in 2019 based on performance data CMS recently released for participants in legacy tracks and those that transitioned or joined Pathways to Success.


The ACO earning the most shared savings bonuses in the Shared Savings Program in 2019 was Palm Beach Accountable Care Organization. The ACO based in Palm Springs, Florida earned a total of $48.6 million in bonuses across both legacy and Pathways to Success tracks.

Palm Beach Accountable Care Organization is a wholly physician-owned and operated provider that boasts 275 primary care providers and 175 specialists. The ACO is responsible for 79,000 Medicare lives, according to its website.

In 2019, the ACO participated in Track 1, earning about $27.9 million in shared savings bonuses, and in the ENHANCED track, earning $20.6 million in shared savings bonuses.


Fort Myers, Florida-based Millennium Accountable Care Organization, LLC earned $26.3 million under Track 3 and $15.6 million under the ENHANCED track for a total of $41.9 billion in shared savings bonuses in 2019.

The ACO is a Millennium Physician Group company that serves Medicare beneficiaries in Southwest Florida. The organization states that it “is unique in the sense that we are a single Tax Identification ACO with a focus on primary care providers.”

Jeffrey Nelson, Millennium Physician Group’s chief information officer, has attributed the ACO’s past successes in the Shared Savings Program to the organization’s ability to treat patients holistically through robust data analytics and population health management efforts.


In 2019, Baylor Scott & White Quality Alliance (BSWQA) earned about $34.3 million in shared savings bonuses. The ACO is affiliated with Baylor Scott & White Health and initially joined the Shared Savings Program in 2015.

This past year, BSWQA participated in both Track 1 and Level E of Pathway to Success’ BASIC track.

Currently, the ACO comprises more than 6,000 primary and specialty care physicians, 50 hospitals, and over 95 post-acute care facilities and other care providers.


Serving Medicare beneficiaries in Michigan, Federation ACO, LLC earned $33.5 million in shared savings bonuses in 2019. That lands the ACO at number four across both legacy and Pathways to Success tracks. But the ACO is number one in terms of shared savings bonuses among organizations participating in legacy tracks.

Federation ACO, LLC is a physician-led organization operated by Affirmant Health Partners, a clinically integrated network of over 5,400 physicians across Michigan’s lower peninsula. It is the tenth largest ACO in the Shared Savings Program.

“Our success can be attributed to the collaboration and hard work of our physicians and local Chapters in organizing as a health care network and putting focus, structure and processes around clinical programs that improve the health of our patients and communities,” William J. Mayer, MD, MPH, president and CEO of Affirmant Health Partners, said in a statement on the 2019 results.


Formed in 2018, the Central Oregon ACO has participated in the Shared Savings Program as a Track 1 ACO. In 2019, the ACO earned $32.9 million in shared savings bonuses.

According to the organization’s website, the Central Oregon ACO is responsible for 11,500 traditional Medicare beneficiaries. The ACO also included six physician practices or groups as of 2017. It is run by the Central Oregon Independent Practice Association.


Mercy Health ACO, LLC provides care for over 73,400 Medicare beneficiaries in Ohio and Kentucky. The ACO is managed by the health system Mercy Health and it earned $24.2 million in shared savings in 2019 under Track 1, placing it at number six on this list.

“For several years, Mercy Health Select has invested resources to improve the quality of care for patients and reduce costs through several actions, including care coordination, preventive health campaigns, closing health care gaps, providing timely access to physicians, and reducing duplication of services,” James Anthony, MD, Mercy Health Select’s board chair, said in a statement. “We are committed to pushing our quality even higher while further lowering costs using innovation and compassion to meet the changing needs of our patients and the communities we serve.”


Receiving $23.4 million in shared savings bonuses in 2019, Silver State ACO LLC comes in as the seventh ACO on the list. This is the fifth consecutive year the Nevada-based ACO has generated savings in the program, and according to the ACO, it was also seventh in total generated savings, first for per beneficiary savings, and second for its savings rate of 10.26 percent in 2019.

Silver State ACO LLC is physician-led but is, in part, sponsored by the Valley Health System, Northern Nevada Health System, and Kindred Healthcare. It currently includes 49 medical practices and over 54,000 attributed beneficiaries, with plans on expanding in 2021.

It was a Track 1 ACO in 2019.


Advocate Physician Partners Accountable Care, Inc. is one of three ACOs affiliated with Advocate Aurora Health. The ACO is the largest of the three, as well as one of the largest in the country. It manages 128,000 Medicare beneficiaries.

Moving from Track 1+ to BASIC Level E, Advocate Physician Partners Accountable Care, Inc. earned $22.7 million in shared savings bonuses in 2019.

In a recent RevCycleIntelligence interview, Advocate Aurora Health’s chief medical office Gary Stuck, DO, FAAFP, shared how the long-time ACO has continued to save Medicare money and earn shared savings.


LTC ACO is the first ACO focused on Medicare beneficiaries residing in long-term care facilities. The ACO formed in 2016 when it joined the Shared Savings Program under Track 1. In 2019, the organization participated in both Track 1 and the ENHANCED track, earning a combined $18.8 million in shared savings bonuses.

Currently, 400 long-term care facilities belong to the LTC ACO. The ACO spans 25 states, according to its website.


Rounding out the top ten list is McLaren High Performance Network, LLC, an ACO run by the $6 billion health system McLaren Health Care in Michigan. The ACO joined the Shared Savings Program in 2017 and earned $17.3 million in shared savings bonuses as a Track 1 ACO in 2019.