Breaking Down the 2024 ACO Quality Performance Report

The 2024 ACO Quality Performance Report from CMS shows how ACOs are performing in the Medicare Shared Savings Program (MSSP).  ACOs can download their report package from the Data Hub tab in ACO-MS by navigating to PY 2024. The package is delivered as a zip file named with the convention: P.Axxxx.ACO.STLMT.D249999.T1111111. You can also review your ACO data in the 2024 ACO CMS Report Viewer below

Beyond explaining past performance, these reports help plan for the future—ACOs can use their 2024 results with MDinteractive’s ACO Quality Score Calculator to model performance under CMS methodology and estimate potential results for 2025.

Background

The Background Quality Performance report section explains the policies and requirements that shape how ACO quality performance is scored under the Alternative Payment Pathway (APP) and the Shared Savings Program. Here’s what you need to know:

1. What is the APP?

The APP is a standardized quality measure set that all Shared Savings Program ACOs must report. It streamlines reporting by requiring a consistent set of measures across ACOs.

2. Reporting Requirements for ACOs (PY 2024)

To meet CMS expectations, ACOs were required to:

• Submit data on the APP quality measure set.

• Report either 10 Web Interface measures or 3 eCQMs/MIPS CQMs/Medicare CQMs.

• Administer the CAHPS for MIPS Survey (if sample size allows).

• Be scored on 2 administrative claims-based measures (if case minimum met).

👉 ACOs missing required sample sizes or case minimums were not scored on those measures.

3. Meeting the Quality Performance Standard

An ACO can meet the standard in three ways:

• Achieve a score at or above the 40th percentile of MIPS benchmarks.

• Use the eCQM/MIPS CQM reporting incentive, which allows meeting thresholds on certain outcome measures.

• For first-year ACOs: simply meet data completeness requirements.

4. Alternative Quality Performance Standard

If the main standard isn’t met, ACOs can still qualify for shared savings at a reduced rate if they:

• Submit the APP measure set.

• Score at or above the 10th percentile benchmark on at least one outcome measure.

5. Consequences of Not Meeting Standards

ACOs that fail to meet either standard:

• Are not eligible for shared savings.

• In the ENHANCED track, may owe maximum shared losses.

Under the BASIC track, ACOs can earn a maximum sharing rate of 40% in Levels A and B, and 50% in Levels C through E. Shared losses begin at Level C, with a 30% rate that continues through Level E. The ENHANCED track offers a higher maximum sharing rate of 75%, with shared losses tied to quality performance. If the ACO meets the quality or alternative quality performance standard, CMS applies the following formula:

Shared Loss Rate = [1 − (ACO’s health equity–adjusted performance score (expressed as a percentage) × Maximum Sharing Rate]

The result is capped between 40% and 75%. For example, if an ACO earns 45% of available quality points, the calculation is [1 − (45% × 75%)] = 66.25%. If the ACO fails to meet either standard, the shared loss rate defaults to 75%.

6. Bonus Points

Eligible ACOs can earn up to 10 bonus points for strong quality performance while serving underserved or low-income populations. 

7. Extreme and Uncontrollable Circumstances (EUC) Policy

If an ACO’s service area is affected by disasters or emergencies, CMS may apply the EUC policy, assigning the higher of:

• The ACO’s actual quality score, or

• The equivalent of the 40th percentile MIPS score.

8. Handling Excluded Measures or Lack of Benchmarks

If a measure is excluded due to errors or lacks a benchmark, CMS adjusts the scoring so ACOs are not unfairly penalized.

Measure Sets

The Measure Sets tab outlines exactly what’s being measured. It includes:

• Measure Titles and IDs (e.g., Influenza Immunization, Tobacco Use Screening, Falls Risk Screening).

• Collection Methods (claims, CMS Web Interface, surveys).

• Measure Types (process vs. outcome).

• Benchmark Status (whether CMS has a performance benchmark for comparison).

APP – CMS Web Interface Measure Set

APP – eCQM/MIPS CQM/Medicare CQM Measure Set

Tables 1-2: Summary Information

These pages provide a report card snapshot of overall quality performance:

• Quality Score (%): The ACO’s composite score.

• Performance Standard Met? Yes or No.

• Alternative Standard Status: Whether additional criteria were satisfied.

This top-level summary helps leaders quickly assess whether they are meeting CMS’s expectations.

Tables 3-4: Detailed Measure Results

This is where the numbers live. Each measure is broken down to show:

• Benchmarks (e.g., 10th percentile, mean performance).

• Performance Rates (numerator/denominator).

• Data Completeness (whether reporting requirements were met).

• Outcome vs. Process Measures, with outcomes weighted more heavily.

These granular details allow ACOs to pinpoint strengths and areas needing improvement.

Table 5: Reporting Incentive

CMS has created incentives for digital reporting. This section highlights the eCQM/MIPS CQM Reporting Incentive, which rewards ACOs that submit electronic quality measures. It underscores CMS’s push toward standardized, digital-first quality reporting.

Table 6: CAHPS for MIPS Survey

Quality isn’t just about numbers — it’s also about the patient experience. This section reports survey results across domains such as:

• Timely care and appointments.

• Provider communication.

• Patient ratings of providers.

• Access to specialists.

Each is compared against CMS benchmarks, providing insight into how patients view care delivery.

Tables 7-8: Bonus Point Results

In some cases, ACOs can earn bonus points for activities like reporting additional measures or demonstrating year-over-year improvement. This tab details how those bonus points are awarded and how they factor into the final score.

Tables R1-R2: Reference Tables

For those who want to understand scoring mechanics, these reference tables explain:

• Decile and percentile thresholds for scoring.

• Crosswalks between benchmarks and points.

It’s essentially a scoring manual showing how raw performance translates into reportable results.

Tables 6-8: Health Equity Adjustment (HEA) Calculation

The final section highlights CMS’s commitment to health equity. It details:

• Eligibility for Health Equity Bonus Points (based on patient demographics).

• Scalers and Multipliers used to calculate points.

• Criteria for ACOs serving underserved populations.

This adjustment ensures that organizations caring for vulnerable communities are recognized and rewarded.

Where Can I Find More Information?

CMS offers extensive guidance to help ACOs interpret their performance:

• MSSP Guidance & Regulations – centralized hub for official program rules and specifications. 

• QPP Resource Library – comprehensive repository for QPP and MIPS guidance. 

Helpful resources include:

Final Thoughts

Why This Matters for 2025

Performance Year (PY) 2025 brings major changes to ACO quality reporting, with the end of the Web Interface, a new APP Plus measure set, and stricter performance standards. To better understand the impact, ACOs can use MDinteractive's ACO Quality Score Calculator to enter their own measure performance rates, see how those scores translate under CMS methodology, and predict potential results for 2025.

Key Takeaway

The PY 2024 results aren’t just a scorecard—they’re a blueprint for success in 2025. By analyzing past performance and preparing for APP Plus, ACOs can meet higher quality standards, earn maximum shared savings, and deliver better care.