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The Medicare ACO model (MSSP) has been focused primarily on generating healthcare cost savings through improving physician compliance with predominantly process quality measures and a small number of outcome measures. To date, the performance of ACOs in terms of savings have not been highly correlated with performance on quality measure scores (i.e. ACOs not achieving savings still have high quality scores). So what is driving the success of ACOs? Is it removing barriers to care for patients, providing additional physician support, improving transitions-of-care/post-acute care spending, or are physicians in ACOs changing the way they practice medicine. My question is informed by having worked at MissionPoint Health Partners, an ACO in the 2012 MSSP cohort, prior to starting medical school.