ABSTRACT
Even prior to the publication of the Final Rule, the ACO concept had evolved beyond the restraints of the Medicare Shared Savings Program (MSSP) and entered the commercial healthcare market. As of May 2012, there were approximately 160 established or developing commercial ACOs.1 Despite the less strict requirements in the Final Rule, as compared to the Proposed Rule, many providers were still not satisfied with the Centers for Medicare and Medicaid Services (CMS) regulations,2 and many opted to create ACOs through value-based purchasing contracts with private payors that emphasize increased quality of care and lower costs. In a less mature form, the commercial ACO market has existed in the healthcare industry long before the MSSP. Some of the largest and most well-known health systems in the United States have been on the path to creating functional ACOs for many years, e.g., Kaiser, Geisinger, Mayo, Cleveland Clinic, large medical groups in California, and several health maintenance organizations (HMO).3
