ACO REACH & MSSP

ACO REACH is entering its scheduled sunset with stronger evidence of Medicare savings—CMS reported $988 million in 2024 savings, up from nearly $695 million in 2023—intensifying pressure on CMS/CMMI under Dr. Mehmet Oz and Abe Sutton to preserve downside-risk momentum through successor pathways rather than let high-performing provider organizations drift back to MSSP-only options (ACO REACH savings). At the same time, organizations accepted into the new LEAD model are facing near-term strategic choices between LEAD and MSSP participation, while CMS’ proposed physician payment/MSSP changes signal a broader push to expand ACO participation, reduce legacy MIPS reliance, and realign physician economics around accountable care. For VBC stakeholders, the core tension is no longer whether Medicare ACOs can generate savings, but how CMS will manage the transition from ACO REACH to LEAD/MSSP without disrupting capital planning, specialist and home-based care partnerships, and provider appetite for two-sided risk (LEAD risk mitigation).