The press on ACOs has been mixed at best… and policymakers and academics seemed puzzled by the lack of sustainable results. But I think that the results are mixed because the incentives for providers and members/beneficiaries/patients are mixed or non-existent. Shared savings as the fuel and the resulting weak incentives once the low hanging fruit are gone is the reason the march to value has stalled. My colleagues at Nascate have developed the tools to achieve sustainable value – built around increased care density (patients use of common physicians) and a better attribution model. The results show that better results and increased value are readily available when incentives are aligned among the various players. Incremental incentives produce incremental results and in this case those results are fading into the past. We have to chart a new path, based on what has been accomplished, but not limited by shared savings and weak incentives. I think this article outlines just one of the results we have seen holding up progress. My take away, from this article and our own experience, is that a “product” strategy is needed (and MA may hold the answer). What is clear, in all our work, is that unfettered and undirected choice produces inferior results.