Contributor: Reimagining Beneficiary Engagement in Accountable Care Models to Make America Healthy Again

Accountable care organizations (ACOs) nurture strong patient-provider relationships to provide high-quality, coordinated health care focused on prevention and chronic condition management. Through these relationships, ACOs have achieved both cost savings and improved patient outcomes compared with fee-for-service arrangements.^1,2 Because of this, CMS aims to bring patients not enrolled in Medicare Advantage (MA) plans into accountable care relationships.³ However, MA plans are not constrained by the same bureaucratic rules that limit ACOs’ engagement with patients, putting ACOs and traditional Medicare patients at a competitive disadvantage.

Over the past decade, the Medicare Shared Savings Program (MSSP) has generated $30 billion in savings, including $6.5 billion in gross savings in 2024 alone, through the delivery of high-quality care to more than 10 million patients.² These financial gains have been matched by strong patient health outcomes including improved control of blood pressure and blood sugar. CMS must unleash ACOs’ ability to engage seniors to increase savings and improve care—aligning with the Trump administration’s strategic plan to promote transparency, increase patient choice and empowerment, and reduce provider burden.

Give Patients a Clearer Choice in Where and How They Receive Care

Beneficiaries weigh many choices when they sign up for Medicare, and for some the complex system can be confusing and overwhelming.⁴ As a result, most beneficiaries don’t know they have the choice to select an accountable care provider, or the benefits it would have for their own health. There is little mention of ACOs in the “Medicare & You” guide compared with the vast amount of marketing materials patients may receive about MA plans. This limits ACO growth and the number of patients who engage in accountable care relationships.

CMS can empower patients and their caregivers to choose where and how they want to receive their care by allowing ACOs to engage in direct patient education and marketing, similar to the approach taken by MA plans. Additionally, CMS should streamline the approach for voluntary alignment to make it a more useful tool for patients to select a primary care provider and become aligned with an ACO, thereby empowering beneficiaries to make informed decisions about their care. Extending alignment options to homebound and facility-based providers would further expand access and improve outcomes.

Nurture Strong Patient-Provider Relationships Through Improved Communication

For those seniors who are engaged in accountable care relationships, the notices they receive may feel counter to the warm connection that they have with their providers. Compliant communications are passive, bureaucratic, and confusing, and miss an important opportunity to better involve patients in their own care. Additionally, the notification requirements are onerous, duplicative, and ineffective, costing providers time and money that could otherwise be reinvested into patient care.

CMS should provide ACOs with the same latitude afforded to MA plans and allow them to tailor outreach to the populations they serve. This can be done in a way that ensures required information is communicated, while strengthening patient-provider relationships in ways that engender trust.

Equip Patients to Be Better Partners in Their Care

The Trump administration wants seniors to have an active role in their own health and care. Many ACOs use interventions like health coaching, chronic disease management, and nutrition counseling to reduce health risks. However, these services still come with out-of-pocket costs that many MA plans are allowed to waive for their patients.

CMS should expand waivers to eliminate or reduce cost-sharing for high-value and preventive services. This would increase tools that support patient access, choice, and prevention, as well as ACO partnerships with community-based organizations to address upstream drivers of health. Policy makers can support these efforts by creating a transparent process to accept public nominations for new waivers and simplifying implementation and reporting processes to reduce burden and promote broad use of waivers.

Accountable care providers share the administration’s goal of empowering patients to make informed decisions. These reforms would strengthen patient-provider relationships, support care innovation, and improve quality for Medicare beneficiaries—while delivering savings to American taxpayers. Let ACOs show their competitive advantage by opening common-sense opportunities for improved patient engagement.

References

1. Bond AM, Civelek Y, Schpero WL, et al. Long-term spending of accountable care organizations in the Medicare Shared Savings Program. JAMA. 2025;333(21):1897‑1905. doi:10.1001/jama.2025.3870

2. Medicare Shared Savings Program accountable care organizations: updated performance year 2024 financial and quality results. CMS. September 29, 2025. Accessed February 5, 2026. https://www.cms.gov/files/document/fact-sheet-ssp-py24-financial-quality-results.pdf 

3. CMS moves closer to accountable care goals with 2025 ACO initiatives. CMS. January 15, 2025. Accessed February 5, 2026. https://www.cms.gov/newsroom/fact-sheets/cms-moves-closer-accountable-care-goals-2025-aco-initiatives

4. Steinzor P. Most Medicare beneficiaries find plan shopping confusing, survey finds. AJMC^®. October 1, 2025. Accessed February 5, 2026. https://www.ajmc.com/view/most-medicare-beneficiaries-find-plan-shopping-confusing-survey-finds