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As part of the transition to value-based care, Medicare Shared Savings Program Accountable Care Organizations (ACOs) have developed a number of strategies to reduce Medicare spending and improve quality of care. This report describes the strategies that selected ACOs have found successful in reducing spending and improving quality of care. These strategies involve working to increase cost awareness in ACO physicians, engaging beneficiaries to improve their own health, and managing beneficiaries with costly or complex care needs to improve their health outcomes. Other strategies that ACOs found successful involve reducing avoidable hospitalizations, controlling costs and improving quality in skilled nursing and home healthcare, addressing behavioral health needs and social determinants of health, and using technology to increase information sharing among providers. ACOs also report challenges in each of these areas and describe the ways they overcame them.