The final ACO rules were published by CMS last month. 

If you subscribe to any health news sources at all, your inbox has been full with analysis and commentary. We've been reading and digesting as well.

There are a lot of details, but the general take-away is that the highly negative reaction to the preliminary rules, with CMS pilloried from all quarters, resulted in a general weakening across the board.  Three sample points:

• There are no more penalties, just up side sharing on the savings.
• The quality measure got reduced.
• There is a pre-payment option for small hospitals that can't afford to invest up front.

If you are a cynical taxpayer, and who is not these days, you might scoff that just a weakened program really does not push hard enough to solve the big Medicare and Medicaid problems.

If you an organization that wants to play in the ACO space, the ante just got lower.  More health systems will now likely tip over and join the party.

If you are trying to read the tea leaves, you see CMS and the administration really, really, really believe ACOs are the way to solve this and are doing everything they can to plant and water seeds, even if the seeds will evolve at a slower pace than originally promised or hoped.