Oz casts accountable care as Medicare’s organizing principle
Accountable care organizations have become the clearest expression of where Medicare policy is headed, and CMS Administrator Mehmet Oz made that case without hesitation at the National Association of ACOs fall conference. In a recorded interview with NAACOS President and CEO Emily Brower, Oz described ACOs as the best way to deliver health care and contrasted them with fragmented fee-for-service medicine, which he called dysfunctional. The message was not subtle: Medicare’s leadership wants more physicians and practices inside accountable care arrangements, and it expects current participants to help pull others in.
Oz tied the policy argument to recent financial returns. Last year, Medicare returned about $4 billion to providers in accountable care relationships, while those ACOs likely saved the government $2.5 billion. Those figures matter because they frame ACOs as more than a theoretical reform; they are being presented as a mechanism that can reward better coordination while also lowering program spending. In practical terms, the model tries to align incentives so physicians are not paid simply for volume but for the quality and efficiency of care across a population.
A single sentence captured the administration’s posture: ACOs are not a side experiment. They are the model CMS wants scaled.
Medicare’s push is aimed at the middle of the quality pyramid
Oz said higher-quality physicians tend to join ACOs because they already think in terms of shared accountability and coordinated care. The harder task, he argued, is engaging the lower half of the quality pyramid, where clinicians may not naturally gravitate toward population-based management. That language reflects a longstanding problem in value-based care: the practices most likely to thrive in ACOs are often the ones least in need of a dramatic cultural shift, while the clinicians who most need support may be least prepared to adopt the model.
For CMS, the policy challenge is therefore not simply recruiting existing winners. It is changing the behavior of practices that still operate in a siloed system, where referrals, follow-up, medication reconciliation and care transitions often fall through the cracks. ACO structures are built to reduce those gaps by making groups responsible for total cost and quality across a patient panel. In theory, that changes the clinical workflow from episodic treatment to longitudinal stewardship, especially for older patients with diabetes, hypertension, cardiovascular disease and multiple chronic conditions.
ACCESS is being positioned as a lighter-weight path into coordination
The CMS Innovation Center’s ACCESS Model is intended to bring technology companies into the accountable care effort in a new way. Oz said 900 companies signed a pledge built by Amy Gleason, leader of CMS’ Office of Health Technology and Products, and more than 100 are developing tools launched with ACCESS for conditions such as diabetes and hypertension. Payment in the model depends on outcomes improving, including a patient’s hemoglobin A1C level.
The clinical logic is straightforward. If a digital tool or remote intervention cannot improve glycemic control, then CMS should not pay for it. That creates pressure for vendors to prove real-world utility rather than simply offer polished software. Oz described the idea as “ACO lite” for a primary care physician who lacks the time or infrastructure to join a full accountable care organization, suggesting that technology could connect practices with specialists and patients without forcing them to build a complete ACO on day one.
Brower said NAACOS members already use patient-facing apps, remote monitoring and artificial intelligence, and they are watching ACCESS for tools that fill care gaps without disrupting the coordination they have already built. Partnership, she said, is critical. The concern is easy to understand: tools that generate data without improving workflow can add burden instead of value. In accountable care, the point is not more information alone. It is actionable information that changes treatment decisions, follow-up timing and patient adherence.
GLP-1 access and obesity policy are being framed as cost control
Oz also pointed to the Medicare GLP-1 Bridge, which offers glucagon-like peptide-1 medications to people who are overweight and at high risk of chronic disease. CMS expects the program to reduce complications and spending within two years. He linked that forecast to the broader cost structure of American medicine, saying two-thirds of the money he spends, and by extension taxpayer dollars, goes to chronic illnesses that are often addressable.
The biological rationale is familiar to clinicians. Obesity drives insulin resistance, hypertension, sleep-disordered breathing, osteoarthritis and cardiovascular risk, so a therapy that reduces weight can affect multiple downstream conditions at once. CMS is treating obesity earlier not as a narrow weight-loss effort, but as an attempt to interrupt the cascade of chronic disease before it hardens into expensive, lifelong utilization. Oz also invoked a broader economic argument, saying Americans may not reach the obesity rates seen in Japan, but they can reach a healthier “playing weight” that improves sleep, mobility and function.
One claim landed with particular force: if healthier Americans retired at 63 instead of 62, the extra year of work would add $1 trillion a year to the economy.
Fraud detection, rural care and ACO accountability
Oz cast ACOs as an early warning system for fraud, waste and abuse, particularly in areas such as skin substitutes. Traditional Medicare does not use prior authorization in the way Medicare Advantage plans do, yet ACOs were still held accountable for costs they could not directly control. That mismatch has made accountable care groups a useful point of detection when spending patterns look suspicious or bills arrive for services no clinician ordered.
Brower described members receiving bills for care they had not requested, including one case in which the billing provider’s address turned out to be a Mail Boxes Etc. location. The anecdote was humorous only on the surface. In real practice, fraudulent billing creates administrative distraction, patient confusion and financial exposure for practices already operating close to the margin. CMS said it has stopped $42 billion in Medicare spending this year, while fraud, waste and abuse total about $100 billion annually.
Rural health was the other major policy theme. Oz described the $50 billion Rural Health Transformation Program as an investment in changing care delivery in rural America rather than simply paying today’s bills. CMS gave the money to governors, he said, because they know their communities better than federal officials do. He also pointed to wide variation in rural needs, comparing Alaska’s North Slope with lower Alabama, and linked the issue to the fact that life expectancy in rural America is almost three years shorter than in urban America.
That gap is not abstract. It reflects fewer clinicians, longer travel times, thinner hospital margins and delayed diagnosis of the same chronic conditions that drive Medicare costs elsewhere.
Benchmarking, local control and the next phase of Medicare payment
CMS also wants ACO benchmarks to depend less on last year’s numbers and more on current conditions in the surrounding environment. In policy terms, that means performance scoring should account for the realities practices face rather than freeze them in older spending patterns that may no longer match local inflation, disease burden or service access. Oz argued that the lowest-ranking person able to make a decision should make it, borrowing from subsidiarity to justify pushing authority closer to the community level.
The next phase of Medicare payment appears to be headed toward more local flexibility, more technology-enabled coordination and stronger financial accountability for outcomes. Oz’s closing message was direct: CMS is trying to make it easier to join an ACO, and the agency sees those organizations as the leading edge of better-quality care. The unresolved question is not whether the model can be expanded; it is whether enough practices outside accountable care will be willing and able to make the operational shift before Medicare hardens the model further.