In 2024, 37.6% of physicians worked in a practice that belonged to a Medicare accountable care organization (ACO), according to the American Medical Association's 2024 Physician Practice Benchmark Survey of 5,000 physicians. The rate was 17.0% in solo practices and 47.1% in multispecialty practices.
Overall, 53.5% of physicians said their practice belonged to at least one ACO type in 2024, down from 57.8% in 2022. The AMA published the figures in a 2025 Policy Research Perspectives report. Every percentage in this post is a share of physicians who answered the survey, and the AMA counts a "don't know" answer as a separate category.
ACO and medical home participation, 2014 to 2024
The AMA runs its survey every two years. Recognition as a patient-centered medical home rose from 23.7% of physicians in 2014 to 34.4% in 2022, then fell to 25.6% in 2024. The AMA links part of the drop to a 2024 rule change at the National Committee for Quality Assurance. The group began to require a full year of standardized electronic quality data taken from certified EHRs.
Medicare ACO participation climbed from 28.6% in 2014 to 38.2% in 2018 and has stayed between 36.7% and 38.2% since. Commercial ACOs are the most common type. They covered 31.7% of physicians in 2016, 45.1% in 2022 and 40.8% in 2024. Medicaid ACOs reached 20.9% in 2016, 30.0% in 2022 and 28.6% in 2024.
| Survey year | Medical home | Medicare ACO | Medicaid ACO | Commercial ACO |
|---|---|---|---|---|
| 2014 | 23.7% | 28.6% | not asked | not asked |
| 2016 | 25.7% | 31.8% | 20.9% | 31.7% |
| 2018 | 31.9% | 38.2% | 26.3% | 39.0% |
| 2020 | 32.3% | 36.7% | 29.5% | 42.7% |
| 2022 | 34.4% | 38.1% | 30.0% | 45.1% |
| 2024 | 25.6% | 37.6% | 28.6% | 40.8% |
Source: AMA Policy Research Perspectives, analysis of the 2014 to 2024 Physician Practice Benchmark Surveys. Share of physicians who answered "yes". The survey added the Medicaid and commercial ACO questions in 2016.
Why the 2024 figures fell
The AMA ties the decline to awareness. In 2024, 34.0% of physicians did not know whether their practice belonged to a Medicaid ACO, against 28.8% in 2022. For commercial ACOs, 31.8% answered "don't know", up from 25.5% in 2022. For Medicare ACOs the share was 25.9%, and for medical homes it was 27.9%.
The share of physicians who are employees rose 8 percentage points between 2022 and 2024, and employed physicians know less about practice-level contracts than owners do. The "no" answers barely moved. For commercial ACOs, 27.4% said no in 2024 and 29.3% said no in 2022.
A physician can answer only for what that physician knows. A 2024 drop of 4.3 points in commercial ACO participation (45.1% to 40.8%) therefore does not show 4.3 points of practices leaving a contract.
Participation by primary care presence
In 2024, 55.2% of physicians were either primary care physicians or worked in a practice that had them. Family medicine, general practice, internal medicine, obstetrics and gynecology, and pediatrics count as primary care in the AMA's definition. Those physicians reported higher participation in all four models.
| 2024 participation | Practice has primary care physicians | No primary care physicians |
|---|---|---|
| Medical home | 36.1% | 10.4% |
| Medicare ACO | 44.3% | 25.6% |
| Medicaid ACO | 31.6% | 19.5% |
| Commercial ACO | 44.0% | 33.7% |
Source: AMA Policy Research Perspectives, 2024 Physician Practice Benchmark Survey. Solo, single specialty and multispecialty practices only.
The medical home gap is 25.7 points, the widest of the four. The Medicare ACO gap is 18.7 points.
Participation by practice type
In 2024, 11.9% of physicians worked in solo practices, 37.2% in single specialty practices and 27.8% in multispecialty practices. The remaining physicians worked in other practice types, which the AMA does not show. Participation rose with practice size and breadth in every model.
| 2024 participation | Solo | Single specialty | Multispecialty |
|---|---|---|---|
| Medical home | 8.5% | 20.7% | 36.7% |
| Medicare ACO | 17.0% | 33.6% | 47.1% |
| Medicaid ACO | 11.6% | 22.8% | 36.9% |
| Commercial ACO | 24.0% | 38.1% | 47.7% |
Source: AMA Policy Research Perspectives, 2024 Physician Practice Benchmark Survey.
Multispecialty practices beat solo practices by 25.3 points for Medicaid ACOs and by 28.2 points for medical homes. Commercial ACOs show the smallest spread, 23.7 points between solo (24.0%) and multispecialty (47.7%).
Participation by ownership
In 2024, 42.2% of physicians worked in physician-owned private practices and 34.5% in hospital-owned practices. The AMA excluded the rest, including private equity-owned practices and direct hospital employees or contractors, from the ownership comparison.
| 2024 participation | Physician-owned | Hospital-owned |
|---|---|---|
| Medical home | 17.5% | 34.7% |
| Medicare ACO | 30.0% | 46.3% |
| Medicaid ACO | 19.9% | 37.0% |
| Commercial ACO | 36.0% | 46.2% |
Source: AMA Policy Research Perspectives, 2024 Physician Practice Benchmark Survey. Physician-owned and hospital-owned practices only.
The gap is about 17 points for medical homes and Medicaid ACOs, 16.3 points for Medicare ACOs and 10.2 points for commercial ACOs. The mix of practices explains part of it. Among physicians in hospital-owned practices, 67.3% had primary care physicians in the practice. Among physicians in physician-owned practices, 45.1% did.
Reading the numbers for one practice
A solo practice sits at the low end of every row above. Its comparison group is the 8.5% medical home rate and the 17.0% Medicare ACO rate for solo physicians. A multispecialty practice sits near 36.7% for medical homes and 47.1% for Medicare ACOs.
Because 25.9% to 34.0% of physicians answered "don't know" in 2024, a practice manager gets a more reliable status from contracts and payer enrollment files than from physician recall.
The survey sample through 2022 was about 3,500 physicians. In 2024 the AMA added 1,500 physicians, for a total of 5,000.
Sources
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