Scoring Methodology

Each ACO receives a composite score from 0 to 100, calculated as a weighted average of five dimensions. ACOs are ranked within their cohort — MSSP Basic Track ACOs are compared only to other Basic Track ACOs, Enhanced Track ACOs only to their peers, and ACO REACH Global and Professional are scored separately. This reflects fundamentally different risk arrangements: MSSP Basic Track ACOs share in savings but face limited downside risk, Enhanced Track ACOs operate under full two-sided risk, and REACH ACOs operate under capitated total cost of care arrangements with risk corridors.

What it measures: Whether the ACO is reducing Medicare spending relative to its benchmark, and whether that trajectory is improving over time.

Why it matters: The fundamental promise of the MSSP program is that organized, coordinated care can reduce unnecessary spending while maintaining quality. Financial performance is the most direct measure of that promise.

Scoring method: Each component is normalized to 0-100 and equally weighted within the dimension. The resulting score is then percentile-ranked within the ACO's cohort — meaning an ACO's financial score reflects how it compares to its peers, not an absolute standard.

Data source: CMS MSSP Public Use File (Performance Year Financial Results) and ACO REACH Financial and Quality Results PUF, published annually on data.cms.gov.

What it measures: The ACO's CMS-calculated quality score and whether quality is improving over time.

Why it matters: Cost savings without quality maintenance is just rationing. The quality dimension ensures that ACOs achieving financial performance aren't doing so at the expense of patient outcomes.

Scoring method: Percentile-ranked within cohort.

Data source: CMS MSSP Public Use File (quality score field) and ACO REACH PUF (QUAL_SCR), published annually on data.cms.gov.

What it measures: Whether the ACO's risk score growth is consistent with expected trends, or whether it shows patterns that may indicate aggressive diagnostic coding.

Why it matters: Risk adjustment is the mechanism by which CMS accounts for how sick an ACO's patient population is. Higher risk scores increase the benchmark, making it easier to show savings. When risk scores grow faster than underlying health status changes can explain, it raises questions about coding intensity — a well-documented concern across Medicare payment models.

This is the novel analytical dimension of our framework. While MedPAC, GAO, and OIG have all documented risk score growth as a systemic concern, there is no publicly available tool that evaluates individual ACO risk score trajectories against expected baselines.

Scoring method: Unlike financial and quality scores, risk integrity uses absolute thresholds rather than percentile ranking. A score of 100 means no risk score concern was detected. Penalties are applied proportionally to how far above thresholds an ACO falls. This is intentional — we want an objective risk assessment, not a relative ranking where even responsible ACOs receive low scores simply because they rank below peers.

Data source: CMS MSSP Public Use File (risk score fields by enrollment type) and ACO REACH PUF (normalized and ratebook risk scores), published annually on data.cms.gov.

All data used in this dashboard comes from publicly available CMS datasets. We do not use proprietary data, claims-level information, or non-public sources.

Our scoring code, methodology, and analytical approach are documented in full here. If you identify an error or want to suggest an improvement, we welcome the conversation.