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For nearly two decades, Better Health Group has been a leader in value-based care and operating top-rated primary care clinics. Our network of owned and independent clinics leverage our model to improve care for both Medicare Advantage (MA) and Traditional Medicare patients. Now, the Centers for Medicare & Medicaid Services (CMS) has ranked Better Health Group in the top 5% of Medicare Shared Savings Program (MSSP), Accountable Care Organizations (ACOs) for performance year 2023.
At a time when independent clinics face mounting challenges, our providers are exceeding CMS quality goals and maximizing shared savings revenue, in every state in which we operate—Florida, Alabama, Georgia, Texas, Oklahoma, and Tennessee.
How Does an ACO Work? The Questions Independent Primary Care Physicians Ask Most
The terminology around Accountable Care Organizations can make a simple idea feel complicated fast. Here are the most common questions we hear from independent primary care physicians.
What is an ACO?
An ACO — Accountable Care Organization — is a group of doctors, hospitals, and other providers that work together to coordinate care for a specific group of patients. For independent primary care physicians, the most relevant type is an MSSP ACO, which operates through CMS's Medicare Shared Savings Program.
In an MSSP ACO, CMS looks at what it would expect to spend on your Medicare patients based on their history. If the ACO manages those patients well enough that actual spending comes in below that estimate — and quality scores meet a minimum threshold — CMS returns a portion of those savings to the ACO and its participating practices.
Does joining a Better Health Group ACO mean giving up my independence?
No. This is the most important thing to understand. Joining a Better Health Group ACO is a payment arrangement, not an employment contract. You keep your practice, your staff, your EMR and your clinical decision-making. You keep billing Medicare exactly as you do now.
The practices that have lost independence in healthcare have overwhelmingly done so through hospital acquisition or private equity deals with other ACOs that take over their practice.
How does the shared savings calculation actually work?
CMS sets a per-patient cost benchmark based on the historical spending pattern of your attributed Medicare patients. At the end of each performance year, CMS compares what your attributed population actually cost against that benchmark. If spending came in low enough — past a threshold called the Minimum Savings Rate — and quality performance is adequate, the ACO earns a share of the difference.
In the Enhanced Track, ACOs can receive up to 75% of the savings generated. As of 2024, the Shared Savings Program has 480 ACOs with over 634,000 providers, serving more than 10.8 million beneficiaries — nearly 50% of Traditional Medicare.
What does "attribution" mean — and does it limit my patients?
Attribution is how CMS determines which Medicare beneficiaries are assigned to an ACO. It's based on where a patient gets most of their primary care, not on any sign-up or enrollment. Your patients don't have to opt in and they're not restricted from seeing other providers.
This is one reason data integration matters so much. Your patients are also going to specialists, urgent care facilities, and ERs that your EMR has no visibility into. A strong ACO partner pulls in claims data, pharmacy data, and hospital encounter data so you can actually see and manage the full picture of your patients' health.
What is downside risk and should I be worried?
Downside risk means that if an ACO's spending significantly exceeds its benchmark, participating practices may owe money back to CMS. The Enhanced Track carries downside risk in exchange for higher savings potential.
Whether it's a real concern depends on the quality of your ACO's population health management. Better Health Group has had 100% of its ACOs earn shared savings for the sixth consecutive year. That's not a guarantee of the future, but it's the most meaningful data point you can evaluate.
What happens if I miss the MSSP enrollment deadline?
CMS's enrollment window is firm. For the 2027 performance year, the deadline is August 5, 2026. Miss it and the next window doesn't open until 2028.
That gap isn't just a year of delayed revenue. It's a year of delayed quality data, benchmark refinement, and operational learning — all of which compound over time. Practices that started earlier consistently outperform those that joined late. CMS is actively working toward having 100% of Traditional Medicare beneficiaries in accountable care relationships by 2030 — and the enrollment window is the only entry point into that system for independent practices.
How long before I see real results?
It varies by practice, panel size, and baseline quality performance. Most practices see meaningful improvement in quality scores within the first year. Shared savings distributions — calculated at year-end and paid out the following year — often begin in year two. By year three, a well-supported practice is typically generating consistent, predictable additional revenue on top of its fee-for-service base.
How Does an ACO Work? The Questions Independent Primary Care Physicians Ask Most
The terminology around Accountable Care Organizations can make a simple idea feel complicated fast. Here are the most common questions we hear from independent primary care physicians.
What is an ACO?
An ACO — Accountable Care Organization — is a group of doctors, hospitals, and other providers that work together to coordinate care for a specific group of patients. For independent primary care physicians, the most relevant type is an MSSP ACO, which operates through CMS's Medicare Shared Savings Program.
In an MSSP ACO, CMS looks at what it would expect to spend on your Medicare patients based on their history. If the ACO manages those patients well enough that actual spending comes in below that estimate — and quality scores meet a minimum threshold — CMS returns a portion of those savings to the ACO and its participating practices.
Does joining a Better Health Group ACO mean giving up my independence?
No. This is the most important thing to understand. Joining a Better Health Group ACO is a payment arrangement, not an employment contract. You keep your practice, your staff, your EMR and your clinical decision-making. You keep billing Medicare exactly as you do now.
The practices that have lost independence in healthcare have overwhelmingly done so through hospital acquisition or private equity deals with other ACOs that take over their practice.
How does the shared savings calculation actually work?
CMS sets a per-patient cost benchmark based on the historical spending pattern of your attributed Medicare patients. At the end of each performance year, CMS compares what your attributed population actually cost against that benchmark. If spending came in low enough — past a threshold called the Minimum Savings Rate — and quality performance is adequate, the ACO earns a share of the difference.
In the Enhanced Track, ACOs can receive up to 75% of the savings generated. As of 2024, the Shared Savings Program has 480 ACOs with over 634,000 providers, serving more than 10.8 million beneficiaries — nearly 50% of Traditional Medicare.
What does "attribution" mean — and does it limit my patients?
Attribution is how CMS determines which Medicare beneficiaries are assigned to an ACO. It's based on where a patient gets most of their primary care, not on any sign-up or enrollment. Your patients don't have to opt in and they're not restricted from seeing other providers.
This is one reason data integration matters so much. Your patients are also going to specialists, urgent care facilities, and ERs that your EMR has no visibility into. A strong ACO partner pulls in claims data, pharmacy data, and hospital encounter data so you can actually see and manage the full picture of your patients' health.
What is downside risk and should I be worried?
Downside risk means that if an ACO's spending significantly exceeds its benchmark, participating practices may owe money back to CMS. The Enhanced Track carries downside risk in exchange for higher savings potential.
Whether it's a real concern depends on the quality of your ACO's population health management. Better Health Group has had 100% of its ACOs earn shared savings for the sixth consecutive year. That's not a guarantee of the future, but it's the most meaningful data point you can evaluate.
What happens if I miss the MSSP enrollment deadline?
CMS's enrollment window is firm. For the 2027 performance year, the deadline is August 5, 2026. Miss it and the next window doesn't open until 2028.
That gap isn't just a year of delayed revenue. It's a year of delayed quality data, benchmark refinement, and operational learning — all of which compound over time. Practices that started earlier consistently outperform those that joined late. CMS is actively working toward having 100% of Traditional Medicare beneficiaries in accountable care relationships by 2030 — and the enrollment window is the only entry point into that system for independent practices.
How long before I see real results?
It varies by practice, panel size, and baseline quality performance. Most practices see meaningful improvement in quality scores within the first year. Shared savings distributions — calculated at year-end and paid out the following year — often begin in year two. By year three, a well-supported practice is typically generating consistent, predictable additional revenue on top of its fee-for-service base.
How Does an ACO Work? The Questions Independent Primary Care Physicians Ask Most
The terminology around Accountable Care Organizations can make a simple idea feel complicated fast. Here are the most common questions we hear from independent primary care physicians.
What is an ACO?
An ACO — Accountable Care Organization — is a group of doctors, hospitals, and other providers that work together to coordinate care for a specific group of patients. For independent primary care physicians, the most relevant type is an MSSP ACO, which operates through CMS's Medicare Shared Savings Program.
In an MSSP ACO, CMS looks at what it would expect to spend on your Medicare patients based on their history. If the ACO manages those patients well enough that actual spending comes in below that estimate — and quality scores meet a minimum threshold — CMS returns a portion of those savings to the ACO and its participating practices.
Does joining a Better Health Group ACO mean giving up my independence?
No. This is the most important thing to understand. Joining a Better Health Group ACO is a payment arrangement, not an employment contract. You keep your practice, your staff, your EMR and your clinical decision-making. You keep billing Medicare exactly as you do now.
The practices that have lost independence in healthcare have overwhelmingly done so through hospital acquisition or private equity deals with other ACOs that take over their practice.
How does the shared savings calculation actually work?
CMS sets a per-patient cost benchmark based on the historical spending pattern of your attributed Medicare patients. At the end of each performance year, CMS compares what your attributed population actually cost against that benchmark. If spending came in low enough — past a threshold called the Minimum Savings Rate — and quality performance is adequate, the ACO earns a share of the difference.
In the Enhanced Track, ACOs can receive up to 75% of the savings generated. As of 2024, the Shared Savings Program has 480 ACOs with over 634,000 providers, serving more than 10.8 million beneficiaries — nearly 50% of Traditional Medicare.
What does "attribution" mean — and does it limit my patients?
Attribution is how CMS determines which Medicare beneficiaries are assigned to an ACO. It's based on where a patient gets most of their primary care, not on any sign-up or enrollment. Your patients don't have to opt in and they're not restricted from seeing other providers.
This is one reason data integration matters so much. Your patients are also going to specialists, urgent care facilities, and ERs that your EMR has no visibility into. A strong ACO partner pulls in claims data, pharmacy data, and hospital encounter data so you can actually see and manage the full picture of your patients' health.
What is downside risk and should I be worried?
Downside risk means that if an ACO's spending significantly exceeds its benchmark, participating practices may owe money back to CMS. The Enhanced Track carries downside risk in exchange for higher savings potential.
Whether it's a real concern depends on the quality of your ACO's population health management. Better Health Group has had 100% of its ACOs earn shared savings for the sixth consecutive year. That's not a guarantee of the future, but it's the most meaningful data point you can evaluate.
What happens if I miss the MSSP enrollment deadline?
CMS's enrollment window is firm. For the 2027 performance year, the deadline is August 5, 2026. Miss it and the next window doesn't open until 2028.
That gap isn't just a year of delayed revenue. It's a year of delayed quality data, benchmark refinement, and operational learning — all of which compound over time. Practices that started earlier consistently outperform those that joined late. CMS is actively working toward having 100% of Traditional Medicare beneficiaries in accountable care relationships by 2030 — and the enrollment window is the only entry point into that system for independent practices.
How long before I see real results?
It varies by practice, panel size, and baseline quality performance. Most practices see meaningful improvement in quality scores within the first year. Shared savings distributions — calculated at year-end and paid out the following year — often begin in year two. By year three, a well-supported practice is typically generating consistent, predictable additional revenue on top of its fee-for-service base.