In terms of the ACO final rules, read my latest blog on the subject. (http://searchhealthit.techtarget.com/healthitexchange/allthingshit/wp-admin/post.php?action=edit&post=345.). Summarizing, the ONC made some great changes...reducing the downside risk for one of the tracks, reducing the number of quality measures, and eliminating the 50% physician EHR attestation requirement. These changes have been well received in the industry.
An ACO model have many success barriers (governance, physician buy-in, etc.). However, the key ingredient to success lies in the technology needed to improve outcomes (EHR analytics, registries, remote monitoring,). Secondly, entities that were classified as PCMH (Patient Center Medical Homes), are in a great position to develop an ACO, because the basic infrastructure is already in place.
Lastly, patient education is going to be key for them to become engaged and accountable. For those patients with chronic disease, I expect a certain level of engagement and accountability already exists.