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.
What is the Medicare Shared Savings Program?
The Medicare Shared Savings Program — commonly called MSSP — is a federal program run by the Centers for Medicare & Medicaid Services (CMS). Created by the Affordable Care Act in 2010, it was designed to reward providers for keeping Medicare patients healthy and reducing unnecessary spending, rather than paying purely based on the volume of services provided.
MSSP operates through Accountable Care Organizations (ACOs) made up of groups of doctors, hospitals, and other providers who agree to coordinate care for a defined group of Medicare patients and are held accountable for their overall health and cost of care.
How does the shared savings work?
CMS sets a spending benchmark for each ACO — essentially a budget for what it is expected to cost to care for the ACO's assigned patients in a given year. That benchmark is based on historical spending data.
At the end of the year, if the ACO spent less than that benchmark and met quality standards, it receives a share of the difference. That payment is called shared savings. How much of the savings the ACO keeps depends on which participation track it is in, how well it performed on quality measures, and whether it has taken on any financial risk.
In Performance Year 2024, Shared Savings Program ACOs earned $4.1 billion in shared savings and saved Medicare $2.5 billion — the highest amount of savings for ACOs and Medicare since the start of the program.
What are the participation tracks?
The Basic track is designed for newer ACOs. At entry level, the ACO shares in savings without financial liability if costs exceed the benchmark. As the ACO advances through the track's levels, it takes on more risk in exchange for a larger share of potential savings.
The Enhanced track is for experienced ACOs willing to take on full two-sided risk — accountable for both savings and losses, with greater upside potential.
Why does MSSP matter for independent primary care practices?
Fee-for-service is paying you less over time. Medicare reimbursement rates under traditional fee-for-service have not kept pace with the cost of running a practice. MSSP creates an additional revenue stream — shared savings distributions — that sits on top of your standard fee-for-service billing. For many independent practices, this has become a meaningful and growing part of total revenue.
The shift to value-based payment is not slowing down. CMS's stated goal is to have 100% of Traditional Medicare beneficiaries in an accountable care relationship by 2030. As of January 2026, 14.3 million Medicare beneficiaries are already receiving care through ACOs — up from 13.7 million just one year prior. Independent practices that are not participating in any value-based arrangement are increasingly on the outside of where Medicare payment policy is heading.
Independent practices are at a structural disadvantage in fee-for-service, but not in value-based care. Large health systems have more leverage in payer negotiations and more resources to absorb reimbursement cuts. Independent practices do not. But in a well-structured ACO, independent physicians can pool their patient populations, share infrastructure costs, and access payer contracts and data tools they could not obtain on their own. The ACO model was in many ways designed with practices like yours in mind.
Your patients may already be attributed to an ACO, just maybe not yours. CMS assigns Medicare patients to ACOs based on where they receive the majority of their primary care. If you are not in an ACO, your patients may be attributed to a competitor's ACO, and any shared savings generated from caring for your patients may flow elsewhere. Participating in MSSP means you have a stake in the value your own practice is already creating.
What does this mean for your practice day-to-day?
Independent practices typically join an existing ACO rather than forming one, since ACOs generally need at least 5,000 assigned Medicare beneficiaries to participate. The ACO handles program infrastructure including data analytics, quality reporting and payer relationships, while your practice focuses on patient care. If the ACO earns shared savings, those funds are distributed to participating providers based on performance and the terms of your agreement.
What you should look for in an ACO partner: transparency in how shared savings are calculated and distributed, support that reduces rather than adds to your team's workload, and a track record of actually earning savings.
The Bottom Line
MSSP is CMS's primary vehicle for shifting Traditional Medicare toward paying for value. For independent primary care practices, that shift is already underway and sitting it out has its own consequences. Understanding what the program is, how it works, and what to look for in an ACO partner is the starting point for making a decision that fits your practice.
What is the Medicare Shared Savings Program?
The Medicare Shared Savings Program — commonly called MSSP — is a federal program run by the Centers for Medicare & Medicaid Services (CMS). Created by the Affordable Care Act in 2010, it was designed to reward providers for keeping Medicare patients healthy and reducing unnecessary spending, rather than paying purely based on the volume of services provided.
MSSP operates through Accountable Care Organizations (ACOs) made up of groups of doctors, hospitals, and other providers who agree to coordinate care for a defined group of Medicare patients and are held accountable for their overall health and cost of care.
How does the shared savings work?
CMS sets a spending benchmark for each ACO — essentially a budget for what it is expected to cost to care for the ACO's assigned patients in a given year. That benchmark is based on historical spending data.
At the end of the year, if the ACO spent less than that benchmark and met quality standards, it receives a share of the difference. That payment is called shared savings. How much of the savings the ACO keeps depends on which participation track it is in, how well it performed on quality measures, and whether it has taken on any financial risk.
In Performance Year 2024, Shared Savings Program ACOs earned $4.1 billion in shared savings and saved Medicare $2.5 billion — the highest amount of savings for ACOs and Medicare since the start of the program.
What are the participation tracks?
The Basic track is designed for newer ACOs. At entry level, the ACO shares in savings without financial liability if costs exceed the benchmark. As the ACO advances through the track's levels, it takes on more risk in exchange for a larger share of potential savings.
The Enhanced track is for experienced ACOs willing to take on full two-sided risk — accountable for both savings and losses, with greater upside potential.
Why does MSSP matter for independent primary care practices?
Fee-for-service is paying you less over time. Medicare reimbursement rates under traditional fee-for-service have not kept pace with the cost of running a practice. MSSP creates an additional revenue stream — shared savings distributions — that sits on top of your standard fee-for-service billing. For many independent practices, this has become a meaningful and growing part of total revenue.
The shift to value-based payment is not slowing down. CMS's stated goal is to have 100% of Traditional Medicare beneficiaries in an accountable care relationship by 2030. As of January 2026, 14.3 million Medicare beneficiaries are already receiving care through ACOs — up from 13.7 million just one year prior. Independent practices that are not participating in any value-based arrangement are increasingly on the outside of where Medicare payment policy is heading.
Independent practices are at a structural disadvantage in fee-for-service, but not in value-based care. Large health systems have more leverage in payer negotiations and more resources to absorb reimbursement cuts. Independent practices do not. But in a well-structured ACO, independent physicians can pool their patient populations, share infrastructure costs, and access payer contracts and data tools they could not obtain on their own. The ACO model was in many ways designed with practices like yours in mind.
Your patients may already be attributed to an ACO, just maybe not yours. CMS assigns Medicare patients to ACOs based on where they receive the majority of their primary care. If you are not in an ACO, your patients may be attributed to a competitor's ACO, and any shared savings generated from caring for your patients may flow elsewhere. Participating in MSSP means you have a stake in the value your own practice is already creating.
What does this mean for your practice day-to-day?
Independent practices typically join an existing ACO rather than forming one, since ACOs generally need at least 5,000 assigned Medicare beneficiaries to participate. The ACO handles program infrastructure including data analytics, quality reporting and payer relationships, while your practice focuses on patient care. If the ACO earns shared savings, those funds are distributed to participating providers based on performance and the terms of your agreement.
What you should look for in an ACO partner: transparency in how shared savings are calculated and distributed, support that reduces rather than adds to your team's workload, and a track record of actually earning savings.
The Bottom Line
MSSP is CMS's primary vehicle for shifting Traditional Medicare toward paying for value. For independent primary care practices, that shift is already underway and sitting it out has its own consequences. Understanding what the program is, how it works, and what to look for in an ACO partner is the starting point for making a decision that fits your practice.
What is the Medicare Shared Savings Program?
The Medicare Shared Savings Program — commonly called MSSP — is a federal program run by the Centers for Medicare & Medicaid Services (CMS). Created by the Affordable Care Act in 2010, it was designed to reward providers for keeping Medicare patients healthy and reducing unnecessary spending, rather than paying purely based on the volume of services provided.
MSSP operates through Accountable Care Organizations (ACOs) made up of groups of doctors, hospitals, and other providers who agree to coordinate care for a defined group of Medicare patients and are held accountable for their overall health and cost of care.
How does the shared savings work?
CMS sets a spending benchmark for each ACO — essentially a budget for what it is expected to cost to care for the ACO's assigned patients in a given year. That benchmark is based on historical spending data.
At the end of the year, if the ACO spent less than that benchmark and met quality standards, it receives a share of the difference. That payment is called shared savings. How much of the savings the ACO keeps depends on which participation track it is in, how well it performed on quality measures, and whether it has taken on any financial risk.
In Performance Year 2024, Shared Savings Program ACOs earned $4.1 billion in shared savings and saved Medicare $2.5 billion — the highest amount of savings for ACOs and Medicare since the start of the program.
What are the participation tracks?
The Basic track is designed for newer ACOs. At entry level, the ACO shares in savings without financial liability if costs exceed the benchmark. As the ACO advances through the track's levels, it takes on more risk in exchange for a larger share of potential savings.
The Enhanced track is for experienced ACOs willing to take on full two-sided risk — accountable for both savings and losses, with greater upside potential.
Why does MSSP matter for independent primary care practices?
Fee-for-service is paying you less over time. Medicare reimbursement rates under traditional fee-for-service have not kept pace with the cost of running a practice. MSSP creates an additional revenue stream — shared savings distributions — that sits on top of your standard fee-for-service billing. For many independent practices, this has become a meaningful and growing part of total revenue.
The shift to value-based payment is not slowing down. CMS's stated goal is to have 100% of Traditional Medicare beneficiaries in an accountable care relationship by 2030. As of January 2026, 14.3 million Medicare beneficiaries are already receiving care through ACOs — up from 13.7 million just one year prior. Independent practices that are not participating in any value-based arrangement are increasingly on the outside of where Medicare payment policy is heading.
Independent practices are at a structural disadvantage in fee-for-service, but not in value-based care. Large health systems have more leverage in payer negotiations and more resources to absorb reimbursement cuts. Independent practices do not. But in a well-structured ACO, independent physicians can pool their patient populations, share infrastructure costs, and access payer contracts and data tools they could not obtain on their own. The ACO model was in many ways designed with practices like yours in mind.
Your patients may already be attributed to an ACO, just maybe not yours. CMS assigns Medicare patients to ACOs based on where they receive the majority of their primary care. If you are not in an ACO, your patients may be attributed to a competitor's ACO, and any shared savings generated from caring for your patients may flow elsewhere. Participating in MSSP means you have a stake in the value your own practice is already creating.
What does this mean for your practice day-to-day?
Independent practices typically join an existing ACO rather than forming one, since ACOs generally need at least 5,000 assigned Medicare beneficiaries to participate. The ACO handles program infrastructure including data analytics, quality reporting and payer relationships, while your practice focuses on patient care. If the ACO earns shared savings, those funds are distributed to participating providers based on performance and the terms of your agreement.
What you should look for in an ACO partner: transparency in how shared savings are calculated and distributed, support that reduces rather than adds to your team's workload, and a track record of actually earning savings.
The Bottom Line
MSSP is CMS's primary vehicle for shifting Traditional Medicare toward paying for value. For independent primary care practices, that shift is already underway and sitting it out has its own consequences. Understanding what the program is, how it works, and what to look for in an ACO partner is the starting point for making a decision that fits your practice.