ACO Quality Measures for Practices: What Counts in 2026 and 2027

Updated October 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

An ACO quality measure is a standardized performance score that helps decide how much shared savings an accountable care organization can keep. In 2026, Shared Savings Program ACOs are scored on eight measures, and LEAD ACOs will be scored on seven starting in 2027. The ones practices influence most are blood pressure control, blood sugar control, follow up after hospital and ED events, and patient experience.

As a clinical psychologist, I read most of these measures as behavior in disguise: a blood pressure reading is a number, but taking the pills and coming back is what moves it.

Key facts

• The Shared Savings Program has 511 ACOs serving 12.6 million people with Traditional Medicare in 2026, per the CMS 2026 ACO participation highlights.
• The 2026 Shared Savings Program measure set lists eight measures: five the ACO reports, a CAHPS patient survey and two claims based measures CMS calculates, per the CMS quality performance standard for 2026.
• The 2026 quality performance standard is a MIPS quality score at or above the 40th percentile, which CMS sets at 73.85, per the same CMS document.
• LEAD starts January 1, 2027 with seven quality measures and 3% of the ACO's benchmark at risk, per the LEAD quality methodology report.
• LEAD's blood pressure and diabetes measures are optional in 2027 and 2028, and an ACO that reports them can earn up to 2.50 percentage points, per the same report.
• In the 2027 Star Ratings, Controlling Blood Pressure, Diabetes Care Blood Sugar Controlled, Plan All Cause Readmissions and the three medication adherence measures each carry a weight of 3, per the CMS 2027 Star Ratings measures and weights.

What are ACO quality measures, and who sets them?

ACO quality measures are the scorecard CMS uses to judge whether an accountable care organization earned its savings with good care or by spending less on everything. CMS picks the measures for each program, and they differ from one program to the next.

An ACO is a group of practices and providers responsible for the cost and quality of care for a defined group of Original Medicare patients. Three scorecards matter to a practice right now. The Shared Savings Program is the permanent one. LEAD is the ten year model that replaces ACO REACH on January 1, 2027, which we explained in our post on ACO REACH ending and what LEAD means for practices. Medicare Advantage Star Ratings are the third.

Star Ratings score health plans, not practices. They still matter to you, because the same clinical measures, such as blood pressure control, show up in your ACO and in your plan contracts.

Which quality measures does the Shared Savings Program use in 2026?

Shared Savings Program ACOs report on the APP Plus quality measure set in performance year 2026. CMS lists eight measures:

• Diabetes: Glycemic Status Assessment Greater Than 9% (ID 001): an intermediate outcome the ACO reports. Lower is better, because it counts patients whose blood sugar is poorly controlled.
• Controlling High Blood Pressure (ID 236): an intermediate outcome the ACO reports.
• Screening for Depression and Follow up Plan (ID 134): a process measure the ACO reports.
• Breast Cancer Screening (ID 112) and Colorectal Cancer Screening (ID 113): process measures the ACO reports.
• CAHPS for MIPS survey (ID 321): a patient experience survey the ACO must administer through a vendor.
• Hospital Wide 30 Day All Cause Unplanned Readmission (ID 479) and Hospital Admission Rates for Patients with Multiple Chronic Conditions (ID 484): outcome measures CMS calculates from claims.

Here's how the pass mark works. To share savings at the maximum rate for its track, an ACO needs a quality score at or above the 40th percentile of MIPS quality scores. CMS averages three older years, with a one year lag:

• 2022 40th percentile score: 77.73
• 2023 40th percentile score: 74.54
• 2024 40th percentile score: 69.27
• Total: 221.54, divided by 3 years, equals 73.85

An ACO that misses that mark can still qualify for a lower, scaled sharing rate if it reaches the 10th percentile on at least one of four outcome measures. An ACO that reports none of the five reported measures and doesn't administer CAHPS fails both standards, earns no shared savings, and owes maximum shared losses if it's in the ENHANCED track. PY 2026 is also the last year ACOs can choose MIPS CQMs for this set.

Which quality measures will LEAD ACOs be scored on in 2027?

LEAD scores seven measures: four claims based measures, one patient survey and two clinical measures reported from electronic data. The two clinical measures phase in slowly, so the first years lean on claims.

• Risk Standardized All Condition Readmission: how many hospital stays lead to a readmission within 30 days.
• All Cause Unplanned Admissions for Patients with Multiple Chronic Conditions: unplanned admissions for people 66 and older with several chronic conditions.
• Days at Home for Patients with Complex, Chronic Conditions: days spent at home or in the community rather than in acute or post acute care.
• Timely Follow Up After Acute Exacerbations of Chronic Conditions: whether patients got follow up care within the recommended window after an ED visit or hospital stay for hypertension, asthma, heart failure, coronary artery disease, COPD or diabetes.
• CAHPS patient experience survey: one survey for all LEAD ACOs.
• Controlling High Blood Pressure and Diabetes: Glycemic Status Assessment Greater Than 9%: reporting is optional in 2027 and 2028, pay for reporting in 2029 and 2030, and pay for performance from 2031.

ACOs that choose to report the two clinical measures in 2027 or 2028 can earn an upward adjustment of up to 2.50 percentage points, worth 1.25 for each measure. ACOs can also earn extra points with a Prevention Quality Plan.

How much money rides on each LEAD quality measure?

In LEAD, 3% of an ACO's benchmark is held at risk for quality, and the ACO earns back some or all of it based on its scores. The withhold isn't taken out of monthly payments. CMS applies it only at financial settlement.

CMS splits the 3% evenly across the measures that count for performance. Here's a worked example with a made up ACO benchmark of $100 million:

• Quality withhold: $100,000,000 times 3% equals $3,000,000
• 2027 and 2028, five measures: $3,000,000 divided by 5 equals $600,000 per measure, or 0.60%
• 2031 onward, seven measures: $3,000,000 divided by 7 equals about $428,571 per measure, which CMS rounds to 0.43%

That's money an ACO can lose, not extra income, and it's an ACO level number. What reaches your practice depends on how your ACO shares savings with participants, so read that agreement closely.

Which Medicare Advantage Star measures matter most to practices?

For the 2027 Star Ratings, CMS gives a weight of 3 to outcome and intermediate outcome measures. A weight of 3 counts three times as much as a weight of 1 in the overall rating, per the CMS technical notes. These are the clinical measures practices touch most:

• Controlling Blood Pressure: weight 3.
• Diabetes Care Blood Sugar Controlled: weight 3.
• Plan All Cause Readmissions: weight 3.
• Medication adherence for diabetes, hypertension (RAS antagonists) and cholesterol (statins): weight 3 each.
• Improving or Maintaining Physical Health and Mental Health: weight 3 starting with the 2027 Star Ratings, up from 1 in 2026.
• Transitions of Care and Follow up after Emergency Department Visit for People with Multiple High Risk Chronic Conditions: weight 1 each.
• Patient experience measures: weight 2, lowered from 4 beginning with the 2026 Star Ratings.

Weights change. CMS removed Medication Reconciliation Post Discharge from the 2027 Star Ratings, and its CY2027 final rule removes 11 measures and adds a depression screening measure for the 2029 Star Ratings. Check each year's technical notes before you plan around a weight.

Which measures show up in more than one program?

Blood pressure control, blood sugar control, readmissions and follow up after acute events appear on two or three of these scorecards. That's the practical map for where to spend effort first:

• Blood pressure: Shared Savings Program ID 236, LEAD Controlling High Blood Pressure, and Star Ratings Controlling Blood Pressure at weight 3.
• Blood sugar: Shared Savings Program ID 001, LEAD Glycemic Status Assessment, and Star Ratings Blood Sugar Controlled at weight 3. The names point in opposite directions, so read each specification before comparing rates.
• Readmissions and admissions: two Shared Savings Program claims measures, two LEAD claims measures plus days at home, and Plan All Cause Readmissions at weight 3.
• Follow up after a hospital or ED event: LEAD's timely follow up measure, and two Star measures at weight 1.
• Patient experience: CAHPS in both ACO programs, and survey measures at weight 2 in Stars.

I haven't seen evidence that any single outreach program moves all of these, so treat that overlap as a way to prioritize, not a promise.

What this means for your practice

Start by asking your ACO two questions: which measures is our TIN scored on, and where do our rates stand today? Ask for measure level reports, not just a summary score.

Then pick the overlap. Blood pressure and A1c sit on every scorecard, and both depend on whether patients take medication and return for a recheck. Check that readings and lab results land in structured fields in your EHR, because the clinical measures are built from electronic data. Set a routine for contacting patients after an ED visit or discharge, inside the window the measure specifies.

Care management programs such as CCM give a practice a paid, structured way to do monthly outreach. Our guide to chronic care management covers the rules. At HANA, we build phone outreach that helps practices reach patients between visits, described on the HANA Remote page.

Frequently asked questions

Do ACO quality measures apply to my Medicare Advantage patients?

No. Shared Savings Program and LEAD measures cover patients assigned or aligned to the ACO through Original Medicare. Star Ratings score Medicare Advantage plans, so they reach you through plan contracts.

What happens if my ACO misses the quality performance standard?

It can still qualify for a lower, scaled shared savings rate if it reaches the 10th percentile on at least one of four outcome measures. If it fails both standards, it earns no shared savings, and ENHANCED track ACOs owe maximum shared losses.

Do I have to report the LEAD blood pressure and diabetes measures in 2027?

No. Reporting is optional in 2027 and 2028, with no penalty for skipping it. ACOs that report can earn up to 2.50 percentage points, and the measures become required in 2029.

Are Shared Savings Program measures the same as MIPS measures?

They overlap. ACOs report the APP Plus set through the MIPS framework, and the pass mark is based on MIPS quality scores. LEAD and Star Ratings use their own lists.

Which measure should a practice improve first?

There's no published ranking, and it depends on your baseline. Blood pressure and A1c are the best first candidates because they appear in all three programs and rely on steady follow up.

Sources

1. Centers for Medicare and Medicaid Services, Medicare Shared Savings Program Quality Performance Standard: Performance Year 2026 40th Percentile MIPS Quality Performance Category Score, December 2025.
2. Centers for Medicare and Medicaid Services, 2026 Medicare Accountable Care Organization Initiatives Participation Highlights, February 2026.
3. Centers for Medicare and Medicaid Services, LEAD Model PY 2027 Quality Measurement Methodology Report, August 2026.
4. Centers for Medicare and Medicaid Services, LEAD Model Frequently Asked Questions, 2026.
5. Centers for Medicare and Medicaid Services, 2027 Star Ratings Measures and Weights, 2026.
6. Centers for Medicare and Medicaid Services, 2026 Star Ratings Measures and Weights, 2025.
7. Centers for Medicare and Medicaid Services, Medicare 2026 Part C and D Star Ratings Technical Notes, September 2025.
8. Centers for Medicare and Medicaid Services, Contract Year 2027 Medicare Advantage and Part D Final Rule fact sheet, April 2026.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you'd like to talk through quality measure outreach for your practice or ACO, book a discovery call.