Which Medicare ACOs Earned the Most Shared Savings?

Latest CMS financial results checked September 23, 2026: performance year 2024, revised July 17, 2026

For the latest published Medicare Shared Savings Program financial file available at this check, Caravan Health ACO 22 LLC received the largest 2024 earned shared savings payment: $127,143,802. Health Connect Partners, LLC followed at $122,660,765, and PBACO Holding, LLC at $107,895,330. These are earned shared savings payments in the CMS 2024 performance file, not 2026 results or total company revenue.

Top 25 ACOs by earned shared savings payment, 2024

The table ranks the positive, unrounded EarnSaveLoss values in the 2024 CMS financial and quality results, revised July 17, 2026. The dollar amounts are displayed as whole US dollars with separators. The source contains 476 ACO rows, each with a unique ACO_ID: 360 have a positive amount, 100 have zero, and 16 have a negative amount. Zero and negative rows are outside this ranking of payments received. There is no tie at the 25th position. The full positive ranking and source manifest are saved with the editorial evidence.

What “earned shared savings” means

In the Shared Savings Program, CMS compares an ACO's performance-year spending with an adjusted benchmark under program rules. Depending on the ACO's arrangement and performance, the reconciliation can produce an earned shared savings payment, no payment, or an amount owed as shared losses. The EarnSaveLoss field reports that reconciled result. The CMS performance data dictionary identifies the field as earned shared savings payments or owed losses.

That payment should not be renamed “revenue.” A hospital, physician group, or other participant may receive Medicare reimbursement and other income streams independently of this ACO-level reconciliation. Likewise, the payment is not the same as the gross difference between spending and the benchmark: sharing rates, quality and other program rules affect the final amount. A high dollar payment is therefore not a direct league table of provider revenue or proof that the ACO caused every dollar of a benchmark difference.

What the ranking shows—and what it does not

The two leading ACOs are close: Caravan Health ACO 22 LLC exceeds Health Connect Partners by $4,483,037 in this file. The third position, PBACO Holding, is $14,765,435 below second. These comparisons are straightforward because the file reports exact whole-dollar values; we did not round to millions before ranking. A chart labeled only in millions could conceal a close tie or reverse nearby positions if used as the sort key.

The list also shows why the ACO ID matters. CMS names can change between years. For example, A4604 appears as “Caravan Health ACO 22 LLC” in the 2024 financial file and “Caravan Collaborative Pathways” in the 2026 organization file. Those are labels from different source years for the same ACO ID in the files used here. We keep the 2024 CMS name in this payment table, because the payment belongs to that performance-year record. Readers seeking the current roster can look up the ID in the 2026 file, but should not present a later name as if CMS had used it in 2024.

Nor is this a list of ACOs “performing best” across every dimension. A large ACO can have a high dollar amount while a smaller ACO could have a different per-beneficiary result. A complete performance assessment would consider assigned beneficiary counts, benchmark and expenditure measures, quality scores, risk arrangement, and consistency across years. The public payment amount answers one narrower question: which ACOs were credited with the largest positive EarnSaveLoss in 2024.

The 100 zero-dollar rows deserve care. A zero in EarnSaveLoss is an observed reconciled value, not a missing ACO or evidence that the organization had no Medicare activity. The 16 negative values represent amounts owed as shared losses in this field; they belong to a different question from “who earned the most payment.” We counted them in the file audit but did not turn negative amounts into positive savings or mix them into the top-payment table. All 476 performance rows remained in the source denominator. A separate analysis of losses could rank those rows by the magnitude of the owed amount with its own explicit title.

Comparing payments responsibly

The ranking is most useful as a starting set of ACO IDs for a specific research question. A payer or market researcher could compare these IDs with their 2024 beneficiary assignment and participant records, but should label each field with its performance year. A prospective partner should also look at multiple annual reconciliations rather than infer a durable trend from one year. The file is a cross-section of 2024 results, so a position at rank 1 is an observation for that year, not a projection of the next payment.

The list can change even without a new performance year if CMS issues a correction or rerun. That is why the file version appears here beside the year. A researcher reproducing this article should use the July 17, 2026 revised file and the exact EarnSaveLoss values. Combining figures from a previous 2024 rerun with names or row counts from this revised release could produce a table that no single CMS source supports. If CMS later publishes 2025 results, those should be handled as a new year and compared through ACO ID with attention to entries, exits, and name changes.

The top-payment ACO is also third in the separate 2026 participant-name ranking under ACO ID A4604. This is an interesting cross-file observation, but it spans a 2024 financial result and a 2026 participation snapshot. It cannot show whether the same participants produced the 2024 payment. Any attempt to explain the payment using network size would need 2024 participant data, beneficiary and benchmark measures, and a causal argument beyond these public rankings. The ACO ID makes a comparison possible; it does not make unlike years interchangeable.

Why the year in the headline matters

The 2026 ACO participation roster and the 2024 performance results describe different periods. A 2026 participant list can include organizations that entered later and omit organizations that received a 2024 result. It would be incorrect to call these 2026 earnings. At the September 23, 2026 check, CMS's performance results collection linked a 2024 file revised on July 17, 2026 as the latest relevant reconciled release. Future releases may change the answer and should trigger a new ranking, not a silent change of the year label.

Methodology

We used only the CMS file named PY_Financial_and_Quality_Results_2024_revised 2026_07_17.csv. We verified 476 rows and one row per ACO_ID, parsed EarnSaveLoss as an unrounded dollar value, and retained only amounts above zero. We sorted descending by the raw value, assigned equal values the same competition rank, and used ACO ID only to order tied display rows. We included all rows at the 25th-position value. The source was retrieved September 23, 2026. The revised CSV is the authority for these dollar figures; QOPE's ACO profile is not asserted to contain this latest financial row.

Explore ACO Networks in QOPE

To extend the analysis, download CMS's 2024 financial file and explore ACO Networks records in QOPE by ACO ID. Keep the payment year attached to any joined network record.

Sources

• CMS Medicare Shared Savings Program Financial and Quality Results Dataset (PY2024, Revised July 17, 2026)
• CMS Medicare Shared Savings Program Performance Year Financial and Quality Results Collection
• CMS Performance Year Financial and Quality Results Data Dictionary
• CMS Medicare Shared Savings Program (MSSP) Overview
• CMS Data Catalog: Accountable Care Organizations