Implementation of the Affordable Care Act and health care reform is under way. A central dimension of this process that has captured health sector interest is development and implementation of accountable care organizations (ACOs). ACOs are formal collaborations of health care professionals who agree to assume responsibility for providing a specific and potentially comprehensive set of health care services to a defined population of at least 5000 Medicare recipients. ACOs are considered to have the potential to reconfigure care-delivery systems to align incentives among physicians, other health professionals, hospitals, and payers (primarily the federal government through Medicare and the federal share of Medicaid) with the goal of increasing perceived value of care, improving clinical outcomes, and lowering health care costs (the triple aim).1 The Centers for Medicare & Medicaid Services has indicated that the secretary of the Department of Health and Human Services will share some portion of savings derived from lower costs of ACO care with ACO clinicians.2
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