Abstract
The Patient Protection and Accountable Care Act (ACA) requires the secretary of health and human services to establish a program within Medicare in which savings from efficient, high-value care are shared with accountable care organizations (ACOs). No demonstration project, this is the start of an ongoing way of paying for care; the program is to be launched in January 2012. The concept is appealing, but right now ACOs don't exist, and regulations regarding qualification as an ACO have not yet been published. Much needs to be done to make this new approach to payment and delivery a reality.

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