The Patient Protection and Affordable Care Act (PPACA) authorizes the development of integrated healthcare delivery systems, such as accountable care organizations (ACOs). The goal of ACOs is to clinically integrate providers for the purpose of reducing costs and improving quality as a team. Although some requirements have been set for ACOs, there are still several legal barriers posed by federal and state laws that could short-circuit this experiment before it has a chance to bend the cost curve and improve the quality of healthcare services.

The good news is that there is an upsurge in activity to address the legal barriers to creating ACOs. The bad news is that there are a lot of uncoordinated efforts that may not lead to near-term, meaningful direction on the best pathway forward toward accountable care.