- Delivery System Reform Hampers ACO Progress on Risk-Based Contracts Modern Healthcare by Maria Castellucci — Accountable care organizations (ACOs) are participating more and more in risk-based contracts, but that progress has been stalled by sluggish care-delivery changes, a new survey suggests. Roughly 50 percent of ACOs are involved in at least one downside risk contract, such as shared savings and capitation contracts, according to a Leavitt Partners and National Association of ACOs report recently published in Health Affairs. About 47 percent of ACOs plan to participate in shared-savings risk-based contracts in the next year or so. However, ACOs are focusing mostly on "low-hanging fruit" strategies to save money and improve quality of care, which mitigates how well the organizations are able to perform in riskier contracts, the report said.