Our ACO in 2025
$9.3M
Below Medicare's spending target in our first year
Medicare Shared Savings Program ACO for Independent Practices
Join a Medicare ACO without giving up your practice.
The VBCA National ACO is a CMS-approved Medicare ACO built for independent practices. You keep your tax ID, your staff, and every clinical decision. We run the ACO, carry the downside risk, and handle the reporting.
Our 2027 participant list locks before January 1
How a Medicare ACO works
Medicare pays for keeping patients healthy, not just for visits
- 1
Your patients are attributed
Medicare assigns patients to the ACO based on where they get most of their primary care. They keep their coverage and can still see any provider they choose.
- 2
Medicare sets a spending target
Each year Medicare estimates what care for those patients should cost, based on their health and history.
- 3
Savings are shared
If the ACO spends less than the target and meets Medicare's quality standard, Medicare pays the ACO a share of the savings, and we distribute it to participating practices.
How our ACO did in its first year
Medicare sets a spending target for the patients in an ACO. In 2025 our ACO spent 7.1% less than its target while meeting Medicare's quality standard. That difference is $9.3 million in savings, which the ACO shares with Medicare.
The gap: $9.3M under target
- Medicare's quality standard
- Met
- of first-year ACOs, historically
- Top 5%
- in MIPS penalties avoided for member practices
- $40M
2025 results are preliminary. Medicare confirms final numbers at reconciliation.
Savings are one of three ways the ACO pays your practice.
What joining pays
Three ways the ACO adds to your Medicare revenue
- On your claims
Care management visits
Annual wellness visits, advance care planning, and chronic care management are billable today, and most practices leave them unbilled. We set up the programs and support your staff. You bill them as usual.
- On your claims
The office-visit bonus
Medicare pays a 16% add-on on qualifying office visits. Every practice can bill it, and many never do. For 2027, Medicare has proposed doubling it to 32% for clinicians on an ACO participant list.
- Once a year
Shared savings
When the ACO beats its spending target and meets the quality standard, participating practices share in the savings. We carry the downside risk, so your practice is not exposed if the ACO misses its target.
Here is what joining could be worth to your practice.
Your estimate
Your numbers, before you ever get on a call
Set your clinicians and weekly Medicare visits. Each line uses the color of its card above, and shared savings are left out, so the total covers only what is paid as you go.
What the estimate assumes
- Medicare billing of $500K a year per clinician.
- Care management valued at $35,000 per clinician a year, from a typical Medicare panel: wellness visits, advance care planning, and chronic care management.
- The office-visit bonus at about $19 per qualifying visit, assuming 70% of visits qualify over a 46-week year.
- The extra ACO bonus at the same amount again. It is proposed for 2027 and not yet final.
- Shared savings are not included.
On your call, we replace every assumption with your real billing.
What our ACO could add to your practice
Set it to match your practice.
Clinicians
3clinicians
Medicare visits a week
45per clinician
Added revenue each year
$270,186
- Care management visitsWellness visits, care plans, monthly check-ins$105,000
- Office-visit bonusOpen to every practice, often never billed$82,593
- Extra bonus for ACO membersProposed for 2027, doubles the one above$82,593
Shared savings come on top, once a year.
Assumes $500K a year in Medicare billing per clinician. We calculate yours from your real billing.
How we calculate thisWho does what
You run your practice. We run the ACO.
Your practice
Stays exactly as it is
- See patients and make every clinical decision
- Bill Medicare the way you do today, under your own tax ID
- Keep your staff, your schedule, and your name on the door
- Offer wellness visits and care plans, with our support
VBCA
Takes on the ACO work
- Hold the ACO's agreement with Medicare and manage the participant list
- Carry the ACO's downside risk
- Report quality for the whole ACO in one submission
- Show you what each patient's care costs, across every provider they see
- Set up care management programs and support your staff
- Track Medicare's rule changes each year and update the program
Why we run an ACO for independent practices
“When program complexity threatens business viability, it threatens healthcare access.”
Independent practices carry the most risk under Medicare's programs and have the fewest people to manage it. Our ACO exists so they can share in the savings without building that department themselves.
From our essay Business Viability Is Healthcare Access · Reviewed by Kristy Reinert, MD
49%
of solo clinicians were penalized under MIPS in the 2025 payment year. 29% took the maximum 9% cut, against 2% of clinicians overall.
Joining, step by step
How joining works
- 1
A 20-minute call
We learn about your practice: specialty, number of clinicians, and how you bill Medicare today. - 2
Your numbers, from your real billing
We run the estimate on your actual Medicare billing, so you see what joining is worth before you commit to anything. - 3
An eligibility check
We confirm your tax ID isn't already on another ACO's participant list and that your group can decide to join on its own. - 4
Sign and join the participant list
You sign a participation agreement, and we add your clinicians to our participant list before it locks for the year. - 5
January 1
The year begins
Care management programs, patient cost data, and quality tracking start with the new year. - 6
After the year closes
Medicare reconciles the year
Medicare checks the ACO's spending and quality. When there are savings, participating practices share in them.
Proposed for 2027
Medicare has proposed doubling the office-visit bonus for ACO clinicians
The 16% add-on stays open to everyone. Clinicians on an ACO participant list would get 32%, on every qualifying visit with a Medicare patient. Medicare finalizes the rule in November.
Read our analysis of the proposalAdd-on to the Medicare payment for a qualifying office visit.
Do I have to merge my practice or change my tax ID?
No. You keep your practice exactly as it is. There is no merger and no change to your tax ID.
Do I give up clinical control?
No. Every patient care decision stays with you. The ACO supplies data and administrative support.
Can my practice lose money if the ACO misses its target?
We carry the downside risk for the ACO, so your practice is not exposed to losses if the ACO spends more than Medicare's target.
Do my patients have to do anything?
No. Patients keep their Medicare coverage and can still see any provider they choose.
What happens to my MIPS reporting?
Joining the ACO does not replace your MIPS reporting. Many of our ACO practices report MIPS through our CMS-approved registry, which is a separate service. We walk through what your practice needs on the call.
How are shared savings split?
Distributions depend on the ACO's results and the terms of your participation agreement. We walk through them on your call, before you sign anything.
Am I locked into a long-term contract?
Participation is voluntary. You can leave if the model doesn't work for you. Our practices stay because the math works.
When can my practice join?
Our participant list for each year locks before January 1. Practices added before then start with the new year. After that, the next chance is the following year.
See what joining is worth to your practice
Book your call
Or email Support@VBCA.com