Along with taking on the risk of a global payment, entering into a ACO arrangement will also require extensive costs in IT infrastructure for providers. From a NEJM article:
Drs. Trent Haywood and Keith Kosel write that HHS is underestimating the anticipated three-year period that it will take providers to recoup the average $1.7 million investment (startup costs and first-year operating expenses as estimated by the Government Accountability Office) in an ACO. For many, even the best-equipped provider groups, it could take seven years or more before they achieve any financial benefit.
http://www.healthleadersmedia.com/page-1/FIN-264180/Are-ACOs-Unaffordable
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