Wilmington Health’s ACO is extending its reach.

 Like other accountable care organizations (ACOs), Wilmington Health’s ACO is intended to ensure that Medicare beneficiaries receive high-quality, value-based care and achieve improved overall health outcomes.

Wilmington Health’s ACO, known as Physicians Healthcare Collaborative, includes provider groups from Tennessee and Florida, making it the second-largest ACO of its type. 

“Collaboration is the key to our success,” said Melissa Odom, chief operating officer of Physicians Healthcare Collaborative. “You can learn from the claims data. Maybe the way eye doctors treat patients in Florida is different than our market, and we might learn from that. … It just helps us all improve.”

In 2023, the most recently publicly reported data, Physicians Healthcare Collaborative generated $116 million in net shared savings across collaborating health care organizations – the most out of the 103 participating ACO REACH groups.

ACOs consist of doctors, hospitals and other health care providers that collaborate to ensure that Medicare beneficiaries receive top-notch preventive care. Although there are different ACO models, typically, an ACO takes accountability for the cost of care.

To be eligible for shared savings, an ACO must pass quality benchmarks set by the Centers for Medicare & Medicaid Services (CMS).
Physicians Healthcare Collaborative follows the ACO REACH model (Realizing Equity, Access and Community Health), which was administered by the Center for Medicare and Medicaid Innovation (CMMI) as a pilot program.

 The ACO REACH model is unique in that it puts the most dollars at risk for an ACO in the CMMI model, said Odom in December. The upside is that ACO REACH offers more shared savings opportunities.

“It does have the most risk and the most reward,” said Jeff James, CEO of Wilmington Health. “However, it also has the most accountability, and we’re here to take care of the community, and we’re willing to say that we will be accountable at a higher level than most organizations are willing to accept.”

Physicians Healthcare Collaborative was formed in 2013 as part of the Medicare Shared Savings Program (MSSP), the largest ACO model. According to James, Wilmington Health was the first commercial ACO in North Carolina and one of the first participants in the MSSP model.
“In the early days, (we were) competing with ourselves because of the model,” Odom said.

Physicians Healthcare Collaborative switched from the MSSP model to ACO REACH in 2023, although because the pilot model winds down at the end of the year, it will have to switch models again soon.

CMMI launched a new model, ACO LEAD (Long-term Enhanced ACO Design), which Physicians Healthcare Collaborative may join, but officials haven’t yet decided.

“It’s not clear how they’re going to set the benchmarking, and that’s really important,” Odom said.

The benchmarking metrics that will influence whether Physicians Healthcare Collaborative joins the new model include attribution methodology, or how patients are assigned to an ACO, and whether there’s a high-performing pool, Odom said.

“We never worry about the quality (benchmark),” James said. “Whatever the quality (benchmark) is, we can knock it out of the park.”

ACO LEAD is a 10-year model, the longest performance period CMS has ever tested, and is designed to continue ACO REACH’s health equity focus. If ACO LEAD isn’t a good fit for Physicians Healthcare Collaborative, James said they may switch back to an MSSP model and that they will likely make a final decision by June.

Beyond Physicians Healthcare Collaborative, Wilmington Health owns and advises multiple ACOs nationwide.

“Our goal is to be a national aggregator of value-based programs,” James said.

The physician-led practice has already begun to make that reality.

In 2025, Wilmington Health partnered with the American Medical Group Association (AMGA) to establish the AMGA Value Care Network, which guides prospective and existing ACOs toward “value-based care success.”

Additionally, Wilmington Health owns PracSync, a strategic services organization that houses additional ACOs and health systems that Wilmington Health advises.

“We’re helping other health systems, not just physician groups, but systems maximize their value-based care programs either in regard to quality and outcomes or cost and utilization,” James said.

James also co-founded an ACO clinical research group, Innovo Research, in 2017, along with Kenny Bilger, CEO of the physician-owned Christie Clinic in Illinois. Innovo Research is focused on population health and, like ACOs, is intent on improving health care outcomes and reducing costs.

James said the research company has found a high correlation between participation in clinical research and value-based care.

“Low cost doesn’t always sound like high quality care,” James said, “and people think you ration care, but we actually don’t. …We want to see patients more for primary care, not less. That’s one of the reasons why the research is so impactful, because it brings in the patients multiple times more per year.”