Last December, the Trump Administration redesigned and set a new direction for the Shared Savings Program, which is Medicare’s main program for Accountable Care Organizations (ACOs) under “Pathways to Success.” Data on ACO performance in the program the first six performance years showed that, over time, those ACOs taking accountability for cost increases, or “risk,” performed better than those that did not. In fact, ACOs that did not take accountability for cost increases and only shared in savings nominally increased Medicare spending relative to their cost targets. The agency also found that ACOs led by physicians (which tend to be “low revenue” ACOs since they provide mostly outpatient services) performed better than ACOs led by hospital systems (which tend to be “high revenue” ACOs since they provide inpatient and outpatient services).