Accountable Care in 2027: Building the Evidence Base and Driving Practical Policy Solutions

As 2027 approaches, accountable care is entering a new phase of evolution. While the model has largely proven more effective than traditional fee-for-service payment, and few stakeholders question the need for greater accountability for cost and quality, there is less agreement on what comes next. Evidence shows accountable care can generate savings and improve population health under risk-based arrangements, yet important questions remain around provider incentives, data sharing, risk adjustment, specialty care integration, and the incorporation of high-cost therapies. Although the field has matured, it has yet to achieve consensus on the policies and infrastructure needed for sustained success or meaningfully bend the cost curve in ways that address affordability concerns.

At the same time, accountable care operates in a markedly different environment than when it emerged. Medicare Advantage now dominates enrollment, health systems continue to face financial strain, and technological advancements—including artificial intelligence, predictive analytics, digital health tools, and…