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Launched by the Centers for Medicare and Medicaid Services (CMS) in 2012, the Medicare Shared Savings Program (MSSP) is the largest Medicare accountable care organization (ACO) initiative and a core endeavor among efforts to transition from fee-for-service to alternative payment models. Existing evidence suggests modest success: ACOs have reduced spending a bit—even after accounting for bonus payments—and they appear to improve at least some dimensions of health care quality. Moreover, savings appear to be growing, at least for ACOs formed by independent physician groups.