According to a study published this month in Health Affairs, although the number of ACO contracts and the proportion of ACOs with multiple contracts have grown, the proportion bearing downside risk has only increased slightly. The research is based on the National Survey of ACOs for the years 2012–18 and includes data on Medicare, Medicaid and commercial ACOs. The study showed, "Only 28% of ACOs formed in 2012 have taken on downside risk, while just 33% had at least one contract with downside risk in 2018." Consistent with findings by the Centers for Medicare & Medicaid, the study found that the ACOs contracting for downside risk tend to have a different and more highly developed structure that integrates hospital and non-hospital services.
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