Commentary: Accountable Care Organizations and Community Empowerment - — JAMA

Less apparent to the public during this period of historic change are the struggles occurring in US board rooms among hospital groups, specialty physicians, and primary care clinicians—debating quietly but intensely over how to form these ACOs, how to be accountable for care delivery, and how to divide anticipated savings derived from ACOs. However, in most of these settings, important constituencies—middle class and other working patients whose health and welfare are at stake—are not included in the discussions.......................The high and accelerating increases in the cost of health care and the limited roles of patients in decision making central to health and health care delivery are too real to ignore. Decision making by distal proxies such as elected legislators may no longer be enough to address the United States' mounting problems with health care, outcomes, and costs.