Accountable care organizations (ACOs) are the keystone of PPACA (Obamacare) as far as restraining costs and improving quality.
Early this year there was great excitement about ACOs in the provider community, but the publication of the (first phase) Medicare ACO rules threw cold water on the concept.
The rules were at best complicated and convoluted and providers ran for the hills. The administration tried calming the fleeing providers with fast track and modified programs, without much success.
On October 20th the Obama administration published revised Medicare ACO rules. The "simplified" rules run 696 pages! Most of us are still reading and analyzing, but the response seems to be less one of fear and more one of disinterest - but time will tell.
The administration finally got smarter and announced modifications to antitrust policy so Obama's DOJ would not be wrecking the work of Obama's DHHS.
Bad news though, employers and insurers see the possibility of intense ACO activity as anti-competitive.
This is a mess.