This policy brief from the RUPRI Center for Rural Health Policy Analysis updates findings from previous RUPRI Center reports that there is continued growth in the number and proportion of Medicare Accountable Care Organizations (ACOs) with participating providers located in nonmetropolitan areas. Well over half (60.3 percent) of all nonmetropolitan counties have at least one ACO provider present – up from 41.8 percent in 2016. Some of this growth in nonmetropolitan ACO presence may be attributed to the development of the ACO Investment Model initiative in 2016, which was designed to stimulate ACO activities in rural and underserved areas. ACOs with significant nonmetropolitan presence were less likely to participate in ACO models involving downside risk.
