Oz puts accountable care at the center of Medicare’s next phase
At the National Association of ACOs fall conference, CMS Administrator Mehmet Oz, M.D., MBA, made an unusually direct case for accountable care organizations as the preferred way to organize American medicine. He framed the model as a corrective to fragmented fee-for-service billing, arguing that accountable care aligns clinicians around quality, coordination, and cost containment rather than volume alone.
His message landed with a policy audience that already understands the structural strain inside traditional Medicare. In Oz’s view, the central task now is not simply to preserve existing ACOs, but to pull more practices into accountable care relationships before the gap between high-performing systems and the rest of the field widens further.
One sentence captured the tone of the discussion plainly: the alternative is a system that rewards disconnection.
Oz said Medicare returned about $4 billion to providers in accountable care relationships last year, while those organizations probably saved the government $2.5 billion. Those figures were presented as evidence that care models built around shared accountability can bend spending without abandoning clinical oversight. For clinicians, the implication is immediate: when attribution, quality measurement, and cost responsibility sit in the same framework, the incentives finally begin to resemble everyday primary care, where preventing the next hospitalization matters more than coding the last one.
Why CMS wants more practices inside accountable care
Oz argued that the physicians most likely to join ACOs are often those already practicing with a population-health mindset. The harder group to reach, in his telling, is the large middle of the system: practices that still operate in a reactive, encounter-based workflow and have not yet reorganized around longitudinal accountability.
That distinction matters because the patients most exposed to fragmentation are rarely the healthiest ones. They are the people with diabetes, hypertension, obesity, or multiple chronic diseases who move between specialists, pharmacies, emergency departments, and family caregivers. In those cases, care gaps do not just create administrative inefficiency. They become missed medication changes, duplicate testing, and preventable deterioration.
Oz called bringing those practices into accountable care a “home run” for patients and for the nation. His broader argument was that Medicare should make the model easier to join, not harder, and that federal policy should move in the direction of scaling systems already proven to coordinate care more effectively.
Technology firms move into an “ACO lite” role
A large part of the conversation shifted to technology and the new ways CMS is trying to extend care coordination without demanding that every practice build a full ACO infrastructure from scratch. Oz described the CMS Innovation Center’s effort to bring technology companies into the payment and care-delivery conversation through ACCESS, the new model meant to support condition-specific outcomes.
Amy Gleason, who leads CMS’s Office of Health Technology and Products, built a pledge signed by 900 companies, and more than 100 are developing tools launched with ACCESS for conditions including diabetes and hypertension. The model pays only when outcomes improve, such as a patient’s hemoglobin A1C level. That structure is clinically meaningful because it ties digital intervention to measurable metabolic improvement rather than to app adoption alone.
“All I care about is did their A1C drop because they were struggling with that issue, and you promised you’d help,” Oz said.
For a primary care physician who lacks the time or staffing to join a full ACO, these products could function as a bridge to specialists, monitoring, and patient engagement. Oz described that role as “ACO lite,” a compact version of care coordination that tries to connect the pieces without forcing every practice through the same administrative doorway.
Emily Brower, president and CEO of NAACOS, said member organizations already use patient-facing apps, remote monitoring, and artificial intelligence, and they are watching ACCESS closely for tools that fill gaps without disrupting the coordination they have built. Her point was practical: technology only helps if it strengthens existing clinical relationships instead of layering another disconnected platform on top of them.
GLP-1 coverage enters the prevention debate
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 payments within two years, a timeline that places prevention squarely inside the financial conversation.
The public health case was blunt. Oz said two-thirds of federal spending goes to chronic illness, much of it potentially addressable. He also cited the U.S. obesity rate of 43%, compared with about 5% in Japan, to show how far the country sits from any realistic ideal. The target is not universal thinness or a European-style social prescription campaign. It is more modest and clinically grounded: helping patients reach a healthier “playing weight” where they sleep better, move more easily, and live with fewer downstream complications.
For clinicians, the significance is less about the slogan and more about mechanism. Weight reduction can improve insulin sensitivity, lower blood pressure, and reduce mechanical stress on joints and sleep physiology. In a system that spends heavily on diabetes, cardiovascular disease, and disability, earlier treatment of obesity is not cosmetic. It is an attempt to interrupt the cascade before it hardens into expensive, chronic harm.
Fraud detection, rural care, and where ACOs fit
Oz also cast ACOs as an early warning system for fraud, waste, and abuse, especially in areas such as skin substitutes. He said Medicare Advantage plans can use prior authorization, while traditional Medicare does not, leaving ACOs accountable for spending patterns they cannot always directly control. He estimated fraud, waste, and abuse at about $100 billion annually and said CMS has stopped $42 billion in Medicare this year.
Brower described the experience from the practice side in concrete terms: patients arrive with bills for services nobody ordered, and one member found a billing address that turned out to be a Mail Boxes Etc. store. The image is almost absurd, but the harm is not. Billing fraud drains trust as well as dollars, and the people left sorting it out are usually clinicians and patients.
Rural care received its own section of the discussion. Oz pointed to the $50 billion Rural Health Transformation Program as an investment in care delivery rather than a short-term subsidy. CMS is distributing the money through governors, whom he described as better positioned than federal officials to understand local needs. He framed the policy through subsidiarity, the principle that the lowest level capable of making a decision should make it.
That approach reflects the enormous variation inside rural America. Oz contrasted the health needs of people living on Alaska’s North Slope with those in lower Alabama, then connected that diversity to one stark outcome: life expectancy in rural America is almost three years shorter than in urban America. The gap is not an abstraction. It shapes who gets preventive care, who reaches a specialist in time, and who arrives in an emergency department already far downstream.
CMS signals a new benchmark philosophy
Oz closed by saying CMS wants ACO benchmarks to depend less on last year’s numbers and more on the environment around each organization. In plain terms, he is signaling that accountability metrics should reflect local pressure, not just historical spending baselines.
That is an important change for systems operating in very different markets. A practice facing workforce shortages, a rural hospital network, and an urban multispecialty group do not start from the same place, and a static benchmark can reward the wrong behavior. The challenge now is whether CMS can preserve rigor while giving organizations enough room to respond to changing patient complexity, local costs, and access barriers.
Oz’s final message was simple: CMS wants to make it easier to join an ACO, and the agency sees those organizations as the front edge of better quality care. The unresolved question is how quickly the remaining practices outside accountable care will move, and whether the new technology and rural funding initiatives can pull enough of them in to change outcomes at scale.