The organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination among providers, according to CMS. All ACOs that succeed in providing high-quality care while also reducing costs will share in the savings to Medicare. Success will be determined by performance on 33 quality measures relating to care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care.

Five of the 27 organizations will start in April and will participate in the advance payment ACO model established by the CMS Center for Medicare and Medicaid Innovation. Under this model, each participating group will receive advance payments to help cover the costs of establishing the infrastructure needed to coordinate care for the beneficiaries they serve; advance payments will be repaid from shared savings earned by the ACO, CMS said.

If an ACO does not complete the full, initial agreement period of the shared savings program, CMS will in most cases pursue full recoupment of advance payments, according to the agency.