Rural Health
Resources by Topic: Accountable Care Organizations
Metropolitan and Nonmetropolitan Medicare Shared Savings Program Assigned Beneficiaries Among Original Medicare Enrollees
Describes trends of Medicare beneficiaries assigned to Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Presents data on metropolitan and nonmetropolitan SSP ACO assignment and Medicare Advantage enrollment between 2018 and 2024, as well as the percentage of original Medicare beneficiaries assigned to an ACO in 2024 by metropolitan status and state.
Additional links: State Tables
Author(s): Fred Ullrich, Keith Mueller
Date: 02/2026
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Describes trends of Medicare beneficiaries assigned to Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Presents data on metropolitan and nonmetropolitan SSP ACO assignment and Medicare Advantage enrollment between 2018 and 2024, as well as the percentage of original Medicare beneficiaries assigned to an ACO in 2024 by metropolitan status and state.
Additional links: State Tables
Author(s): Fred Ullrich, Keith Mueller
Date: 02/2026
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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A Comparison of Independent and System-Affiliated Rural Hospitals
Compares independent and system-affiliated rural hospitals by organizational characteristics, financial performance, and county characteristics. Presents Medicare Cost Report data from 2023-2024 on the number and percentage of independent and system-affiliated rural hospitals by state, ownership characteristics, Medicare payment classification, use of swing beds, financial distress, and more.
Author(s): Aditya R. Pillutla, Sruthi Malavika Srinivasan, Kristie Thompson, George Pink, Tyler Malone
Date: 02/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Compares independent and system-affiliated rural hospitals by organizational characteristics, financial performance, and county characteristics. Presents Medicare Cost Report data from 2023-2024 on the number and percentage of independent and system-affiliated rural hospitals by state, ownership characteristics, Medicare payment classification, use of swing beds, financial distress, and more.
Author(s): Aditya R. Pillutla, Sruthi Malavika Srinivasan, Kristie Thompson, George Pink, Tyler Malone
Date: 02/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2026. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2026. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Rural-Urban Disparities in Diabetes Quality of Care with Accountable Care Organization Participation
Examines the relationship among diabetes quality of care, Accountable Care Organization (ACO) participation, and rural versus urban health disparities. Utilizes 2011-2018 Wisconsin Collaborative for Healthcare Quality all-patient all-payer data to analyze diabetes care management across ACO versus non-ACO participation and rural versus urban location.
Author(s): Mariétou H. Ouayogodé, Xiyuan Hu
Citation: Journal of Rural Health, 42(1), e70121
Date: 02/2026
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Examines the relationship among diabetes quality of care, Accountable Care Organization (ACO) participation, and rural versus urban health disparities. Utilizes 2011-2018 Wisconsin Collaborative for Healthcare Quality all-patient all-payer data to analyze diabetes care management across ACO versus non-ACO participation and rural versus urban location.
Author(s): Mariétou H. Ouayogodé, Xiyuan Hu
Citation: Journal of Rural Health, 42(1), e70121
Date: 02/2026
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RHCs and CAHs Participating in the Medicare Shared Savings Program (MSSP): Characteristics of the Providers and Communities
Describes the characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) currently participating in the Medicare Shared Savings Program (MSSP) in 2023. Compares CAH and RHC characteristics by MSSP participation, ownership status, and freestanding versus provider-based RHC status.
Author(s): Edmer Lazaro, Dan Shane, Fred Ullrich, Keith Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Describes the characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) currently participating in the Medicare Shared Savings Program (MSSP) in 2023. Compares CAH and RHC characteristics by MSSP participation, ownership status, and freestanding versus provider-based RHC status.
Author(s): Edmer Lazaro, Dan Shane, Fred Ullrich, Keith Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Beneficiary and Clinician Perspectives on Medicare and Other Issues: Findings from 2025 Focus Groups in St. Louis, Missouri, and 2021–2025 Rural Focus Groups
Summarizes findings from 8 focus groups of Medicare beneficiaries, Medicare and Medicaid (dual eligible) beneficiaries, and clinicians conducted between April and May 2025, including one virtual focus group of rural Medicare beneficiaries. Compiles findings from 13 focus groups of rural Medicare beneficiaries between 2021 and 2025. Highlights themes that emerged across the focus groups covering Medicare coverage options, access to care, telehealth, organization of care, and prescription drugs.
Date: 06/2025
Sponsoring organizations: Medicare Payment Advisory Commission, NORC at the University of Chicago
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Summarizes findings from 8 focus groups of Medicare beneficiaries, Medicare and Medicaid (dual eligible) beneficiaries, and clinicians conducted between April and May 2025, including one virtual focus group of rural Medicare beneficiaries. Compiles findings from 13 focus groups of rural Medicare beneficiaries between 2021 and 2025. Highlights themes that emerged across the focus groups covering Medicare coverage options, access to care, telehealth, organization of care, and prescription drugs.
Date: 06/2025
Sponsoring organizations: Medicare Payment Advisory Commission, NORC at the University of Chicago
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2024 National CAH Quality Inventory & Assessment National Report
Presents a high-level summary of key data points from the September-November 2024 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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Presents a high-level summary of key data points from the September-November 2024 National Critical Access Hospital (CAH) Quality Inventory and Assessment. Includes data on CAH system affiliation; median average daily census and emergency department volume; median swing bed admissions and swing bed length of stay; hospital inpatient, behavioral health and specialty care, and outpatient and other service lines; and CAH quality payment model participation.
Date: 05/2025
Sponsoring organization: Flex Monitoring Team
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Sustainability Strategies for Community-based Palliative Care
Summarizes themes from two roundtable discussions conducted in late 2018 with 9 rural palliative care programs in Minnesota and surrounding states. Offers examples and resources for sustainability strategies to support community-based palliative care programs.
Date: 05/2025
Sponsoring organization: Stratis Health
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Summarizes themes from two roundtable discussions conducted in late 2018 with 9 rural palliative care programs in Minnesota and surrounding states. Offers examples and resources for sustainability strategies to support community-based palliative care programs.
Date: 05/2025
Sponsoring organization: Stratis Health
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Goal Alignment and Unintended Consequences of Accountable Care: How the Structure of Oregon's Medicaid Coordinated Care Model Shapes Health Plan-Clinic Partnerships
Analyzes how the coordinated care organization model in Oregon impacts payers and primary care clinics through building relationships, metrics reporting, electronic health record technical assistance, training, and implementing alternative payment methods. Includes discussion of the impact on rural clinics and rural health outcomes.
Author(s): Erin S. Kenzie, Jean Campbell, Mellodie Seater, et al.
Citation: Journal of Clinical and Translational Science, 9(1)
Date: 02/2025
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Analyzes how the coordinated care organization model in Oregon impacts payers and primary care clinics through building relationships, metrics reporting, electronic health record technical assistance, training, and implementing alternative payment methods. Includes discussion of the impact on rural clinics and rural health outcomes.
Author(s): Erin S. Kenzie, Jean Campbell, Mellodie Seater, et al.
Citation: Journal of Clinical and Translational Science, 9(1)
Date: 02/2025
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