ACOs that include health centers perform at par

A question with real policy stakes and, until now, no published answer: do Medicare ACOs that include Federally Qualified Health Centers underperform? In PY2024 data, no. Quality 82.8 vs 83.3 (median), an identical 4.21% median savings rate, and a higher share met the quality standard (95% vs 93%).

Group	ACOs	Quality score (med)	Savings rate (med)	Met quality standard
ACOs including ≥1 health center	123	82.8	4.21%	95%
ACOs with no health centers	353	83.3	4.21%	93%

123 Medicare ACOs include at least one FQHC. On the program's own yardsticks, they are indistinguishable from the rest — and slightly more likely to meet the quality standard.

Read this carefully: One performance year; ACOs that recruit FQHCs may differ in other ways. Parity is the finding — not superiority in either direction.

Source: CMS Medicare Shared Savings Program PY2024 results PUF (476 ACOs; 123 include ≥1 FQHC). Computed 2026-06-12; reproducible from the analysis code against the files hashed on the methodology page.

Safety-net providers can carry value-based risk. What they need isn't a different standard — it's the same data infrastructure better-funded systems take for granted.

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