Caravan Health is adding four accountable care organizations and 25 health systems to its Medicare Shared Savings Program business, the consulting firm announced Monday.

Caravan Health agreed to absorb health systems’ losses if their costs exceed projections. Typically, providers only pay Caravan when they earn shared savings.

ACOs and physicians working with Caravan Health have earned more than $235 million in shared savings and saved Medicare $476 million since 2014, according to the company. All of its ACO participants collected shared savings from 2019 through 2021, the company said.

“Our collaborative ACOs have been leading their markets in value-based care, enabling our clients in community health systems to participate successfully in shared savings with little risk,” Caravan Health CEO Tim Gronniger said in a news release. “We provide our ACO partners with coaching, accountability tools and advanced clinical workflows to close gaps in care, track quality and alleviate physician burnout.”

Before the Centers for Medicare and Medicaid Services finalized regulations last year that required providers to transition to downside risk, Caravan Health began consolidating its ACOs. The company increased the number of beneficiaries in each group and shifted from 38 ACOs to 12. Now, Caravan Health operates six ACOs covering more than 600,000 Medicare enrollees.

Providers participating in Shared Savings Program ACOs will treat about one-fifth of Medicare beneficiaries this year, according to CMS. ACOs are projected to cover 11 million people this year, compared to 10.7 million in 2021 and 11.2 million in 2020.

Summit Healthcare of Show Low, Arizona, and Holy Name Medical Center in Teaneck, New Jersey recently joined one of Caravan Health’s ACOs.

“Caravan Health enables us to maintain our autonomy and manage governance at the local level while being part of a much larger ACO, increasing our chances of success in value-based health care,”, Summit Healthcare CEO Shawn Morrow said in a news release.