Driving Measurable Value: The Garage's 2026 ACO Operational Framework

As Accountable Care Organizations (ACOs) adapt to the increasing complexities of value-based care, the Garage's 2026 Operational Framework offers more than just a roadmap; it delivers a connected ecosystem that aligns people, processes, and technology. Designed to drive measurable outcomes, it empowers care teams to optimize delivery, close critical gaps, and engage patients more effectively, all while fostering long-term, sustainable growth.

Why ACO Operational Frameworks Matter in 2026

As 2026 approaches, the regulatory landscape is becoming increasingly complex, placing greater demands on Accountable Care Organizations (ACOs). CMS has elevated performance benchmarks under the Medicare Shared Savings Program (MSSP), tightened requirements for digital quality reporting, mandated health equity stratification, and accelerated the shift toward downside risk participation. Simultaneously, the federal TEFCA framework is advancing interoperability requirements, all while organizations continue to face persistent workforce shortages and growing clinician burnout.

Compounding these pressures is the One Big Beautiful Bill Act (OBBBA), which reshapes Medicaid eligibility and introduces more stringent administrative requirements. The ripple effects of OBBBA are significant, from increased documentation complexity and workforce strain to heightened financial exposure, particularly for Medicaid-heavy populations and behavioral health providers.

In this context, ACOs require operational frameworks that:

• Support the rapid adoption of digital quality reporting by 2025/26, including fully electronic clinical quality and modernized patient experience measures.
• Align with mandatory stratified equity reporting and embed interventions informed by social determinants of health (SDOH) data.
• Prepare for escalating downside risk and multi-payer contract complexities with transparent financial risk adjustment and benchmarking.
• Reduce administrative burden growth amplified by OBBBA with AI-driven automation and workflow redesign.
• Deliver scalable, secure interoperability solutions compliant with TEFCA and USCDI v4 standards to ensure seamless cross-organizational data exchange.
• Build workforce efficiency models that alleviate burnout and optimize clinical focus.

The Garage Framework unites clinical, financial, and operational data in a connected ecosystem that not only addresses these evolving requirements but also strengthens care quality, improves patient engagement, and drives sustainable financial performance.

The Framework: A Puzzle of Performance

The Garage Framework is purpose-built to deliver on the Quintuple Aim, bringing together advanced analytics, interoperable data infrastructure, and AI-driven workflows into a single, cohesive ecosystem.

Success Metrics That Matter

Garage aligns success evaluation with its guaranteed ROI framework, which includes:

• ROI realized in under 6 months
• 20% reduction in avoidable admissions
• 12% reduction in readmissions
• 20% increase in timely annual wellness visit (AWV) completion
• More than $1 billion in cumulative ACO savings

In Performance Year 2024, Garage-supported ACOs generated $140.16 million in gross savings, a 40% improvement over the previous year. With 83% of ACOs achieving savings, an average quality score of 83.3%, and 68% qualifying as high-performance ACOs, these results underscore the framework's impact in practice.

These outcomes also incorporate patient experience enhancements through alignment with modernized CAHPS reporting and patient-reported outcome measures (PROs), reflective of CMS quality evolution.

Governance & Compliance

The Garage platform integrates governance structures supporting CMS Final Rule adherence, HIPAA, CPT and Risk Adjustment (RAR) integrity, aligned with HiTrust and ONC standards. Embedded change management enables agile adaptation to regulatory shifts.

Governance capabilities also absorb the increasing requirements for fraud and abuse monitoring, audit preparedness, and equity compliance frameworks-building trust and operational resilience into routine workflows.

In response to CMS's pivot to exclusively digital quality measures and expanded patient experience mandates, governance processes support seamless capture and validation of PROs and CAHPS digital data.

The new administrative burdens introduced by OBBBA necessitate enhanced compliance diligence, which the platform addresses through integrated audit support and data integrity protocols.

Care Services That Scale

The framework facilitates scalable delivery of care services, including:

• AWVs and chronic care management (CCM) enhanced by AI-driven care plan assist
• Transitional Care Management (TCM) workflows designed to reduce readmissions
• Virtual care and telehealth expansion to improve access for rural and underserved populations
• Longitudinal care coordination supporting synchronous and asynchronous touchpoints

This scalability accommodates ACO heterogeneity, from small rural entities needing low-touch solutions to large health systems requiring standardized multi-site operational consistency.

Technology & Interoperability: Powering Precision at Scale

At the core of Garage's ecosystem is the Bridge Rollout, ensuring interoperability across multiple EHR platforms and payer systems. The Genome Fire Connector advances deep integration with Epic and other major EMRs to surface real-time clinical insights and actionable care gaps.

BlazeSpeaks offers a low-friction, browser-based overlay delivering context-sensitive intelligence at the point of care to support workflow efficiency and coding accuracy.

These components collectively provide:

• Immediate access to actionable data
• Bi-directional communication across care and payer settings
• Scalable integration of social, laboratory, and claims data-including bidirectional exchanges with community-based organizations facilitated by Health Gorilla
• Compliance with eCQMs, MIPS, and emerging CMS interoperability mandates such as USCDI v4

In light of TEFCA's data-sharing ecosystem rollout, these capabilities underpin ACOs' readiness to meet intensive interoperability and data liquidity expectations.

Data & Platform Intelligence: Unified, Secure, Scalable

Trusted partnerships with entities like Health Gorilla, Labcorp, Experian, and FindHelp empower the platform to aggregate and normalize clinical, claims, and social determinants data. This extensive dataset feeds role-based dashboards (Blazeboard, Insights, Grid) delivering prescriptive insights that support quality, equity, and operational goals.

The platform's inclusion of equity analytics and population stratification tools facilitates closing care gaps aligned with CMS's health disparity reduction requirements.

Applied Intelligence with BlazeAgents: Automation That Delivers

BlazeAgents leverage AI to automate workflows, reduce administrative burden, and improve provider experience:

• BlazeSync automates outreach for care transitions
• BlazeLink recoups lost revenue through claims optimization
• BlazeSpeaks supports point-of-care documentation and gap closure

These automation tools align closely with the Office of Burden Reduction and Behavioral Analytics (OBBBA) initiative, aimed at reducing provider workload through technology, thereby sustaining clinical capacity in increasingly resource-constrained environments.

Financial & Risk Strategy

The Garage framework incorporates detailed financial risk management via CMS-HCC, HHS-HCC, Milliman/Mira, and Johns Hopkins risk models, augmented by provider scorecards for transparent performance tracking.

Increasing downside risk participation under MSSP, combined with OBBBA-induced Medicaid eligibility complexities, underscore the necessity of comprehensive financial visibility and scenario modeling.

Forward-looking analytics support preparation for prospective payment models and contract multipliers, enabling sustainable margin management despite pressure on Medicaid and ACA populations.

Platform resilience is bolstered through cybersecurity best practices, infrastructure redundancy, and proactive monitoring aligned with evolving CMS and federal data security standards.

Implementation Timeline

Garage enables rapid deployment with a 6-12 week initial rollout, supporting phased adoption of core services, data ingestion, and platform integration.

Provider Engagement & Change Management

Embedded provider tools include role-based dashboards, peer benchmarking, bidirectional communications, and "train the trainer" education programs. These support scalable workforce adoption and align engagement efforts with CMS quality and patient experience goals-including modern CAHPS and PROs capture.

OBBBA-related increases in administrative requirements reinforce the importance of these tools in maintaining clinical focus and reducing burnout.

SDOH & Population Health

The framework's integration with Experian, FindHelp, and Labcorp enables targeted social risk interventions via tailored outreach campaigns. Health Gorilla's bidirectional exchange fosters community-based partnerships and ensures closed referral loops, critical for addressing mandated health equity reporting.

Built for Trust: Certifications & Security

The Garage platform includes:

• ONC Certified components (Bridge, Ignite) for CMS quality program data integration
• SOC 2 Type II and HITRUST i1 Certifications with top scores
• NCQA HEDIS and eCQM Certified quality enablement
• Zero-trust security architecture and US-based data centers

How to Apply This Framework

The 2026 framework adapts to diverse ACO profiles:

• Emerging ACOs leverage Bridge for data unification and Blazeboard for immediate quality tracking.
• Rural ACOs extend care capacity and financial sustainability through BlazeSync and BlazeLink, coupled with targeted SDOH outreach.
• Large multi-EHR health systems integrate diverse clinical sources with Genome Fire and streamline workflows with BlazeSpeaks.
• Advanced risk or payer-provider coalitions employ robust risk adjustment models and Insights Grid analytics to maintain financial viability.

Across all types, BlazeAgents augment efficiency, connecting frontline care to organizational goals mitigating equity gaps and optimizing financial outcomes.

Final Thoughts

The Garage 2026 Operational Framework combines regulatory alignment, AI-powered automation, integrated care services, and robust data interoperability to prepare ACOs for the dual challenges of increasing CMS requirements and evolving Medicaid policy shaped by OBBBA. By supporting financial predictability, reducing administrative burden, and advancing equity, this framework equips organizations to succeed in 2026 and beyond.