The average actual start-up costs of the respondents in the first 12 months of operation were $2.0 million with a range from $300,000 to $6,700,000. Since savings are slow to flow as result of data and complex reconciliation process, ACOs will have almost a second full year of operations until their cash flow can be replenished with shared savings from CMS (if any). This means that the average ACO will risk $3.5 million plus any feasibility and pre-application costs. We estimate that in total, ACOs on average will need $4 million of startup capital until there is a chance for any recoupment from savings.
• 13 ACOs broke even• 9 ACOs gained an average $1.3 million• 6 ACOs lost an average of $1.3 million• 6 ACOs did not know or did not report