Accountable care organizations, are a new organization of healthcare, combining some aspects of insurance and health systems. They are collaborations which are paid a capitated rate, based on risk, and provide all care to these beneficiaries. If they show savings beyond what they are paid, they receive about half as an “incentive.” Savings cannot be achieved at the cost of patient safety and outcomes, so that “quality measures” must be met. For those showing greater costs, losses, what happens is less clear. The federal plan was to have these ACOs move from the safe environment where losses carried no real consequences, to a risk-based approach where there was “skin in the game,” and you might lose money. Oddly enough, few ACOs are moving from phase one where there are only incentives to phase two where money is on the table.