Regarding "We can have it all":
I certainly respect Dr. Berwick and applaud many of the quality initiatives addressed under the Patient Protection and Affordable Care Act, but I believe the concept of the accountable care organization has been limited by two items: 1) the savings/payment is, by every timeline I have seen, after the three-year required period. This is being addressed in the initiative to consider some prepayment up front. 2) The concept of the ACO precludes the key element I believe is needed for success: accountability of the beneficiary/patient. Without this, the three-legged stool remains a two-legged stool.