The key missing ingredient is patients with skin in the game. They are not asked to commit to an ACO, but are assigned by PCP proxy. Providers are asked to invest in systems and people without a committed patient base. While this choice makes it an easier political sell, it threatens ultimate success.

I have been down this road before in 1995. My Mom was very, very sick and the doctor would not admit her to the New England Baptist Hospital because he said "Once you get them in you can't get them out." She was so sick that he let me have visiting nurses but would not let her in the hospital to be diagnosed with what was wrong with her. The denial of care was horrendous. This is just a repeat of that. We already have the diagnoses related groups with bonus payments, if a hospital can kick out a senior before their allotted time. This is only worse. Just remember the seniors paid into an insurance system all their lives and now they are being cheated by rationed medicine. Give doctors a financial carrot to not treat and they wont. The only way the doctors and hospitals will be paid well is to deny care with aco. The case for aco was that doctors only got paid was by seeing patients and ordering unnecessary hospitalizations and tests (which is totally untrue)but that was the argument for aco. The converse is now they will get paid better for not doing their doctoring. This is ridiculous. Forget about accountability. When your Mom or Dad are in the grave who is going to care.

"The Centers for Medicare and Medicaid Services has laid out 33 quality measures it will use to evaluate ACOs" Wow, 33 indicators. I am sure that will ensure "quality" and no one will just target there efforts on these indicators ignoring other equally important patient care issues unattended to. In reality this is the return of capitation and managed care. When this was tried last and failed it led to hospital closures and downsizing, the replacement of trained professionals with minimally trained ones, and the shortest hospital stays of any developed nation. It left us with a system that is unable to respond to the slightest strain (like those long ER waits to be admitted? thank managed care). "It's different this time,'' - You will be able to leave an individual managed care organization for another (Actually CMS did want to restrict people but were afraid of a revolt so they decided not to). The problem will not be caused by a specific managed care origination but manged care itself.

This seems like an excellent idea. Give incentives to care providers to keep their patients healthy. We can do something like this with the under-65 crowd too. Transfer employees from health insurance companies into preventive care, and administration. Costs will be massively reduced.