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Even as most value-based payment (VBP) models fail to generate savings, public officials and industry leaders tout the ostensible success of Medicare’s accountable care organizations (ACOs). In a recent Health Affairs Forefront article, Biden Administration officials celebrated the $2.1 billion in savings in 2023 in the signature Medicare Shared Savings Program (MSSP), marking five years of cost reductions. As depicted in exhibit 1, analysis of data from the Medicare Shared Savings Public Use Files from 2013 to 2023 shows that shared savings payments to ACOs have ballooned to $301 per beneficiary in the 2023 performance year, up from $85 per beneficiary in 2013. In 2023, 77 percent of beneficiaries were in MSSP ACOs that achieved shared savings, up from 25 percent in 2013. These shared savings payments are often cited as proof of the win-win that VBP proponents always envisioned: ACOs are reducing total costs without sacrificing quality, Medicare is saving money, and ACOs generating savings get to pocket a portion of it as profit.