Now that we have sweeping new health care legislation, the Patient Protection and Affordable Care Act, let's look at the rollout of the accountable care provisions—i.e., those changes to the payment and delivery system that hold the most long-term promise of improving quality and cost-efficiency. They are discussed below in the chronological order of their effective dates, referenced by the relevant title and section of the act, followed by comments as to their implications for accountable care organizations (ACOs). Keep in mind as you read these summaries the framework for health care quality provided almost a decade ago by the Institute of Medicine (IOM) in Crossing the Quality Chasm, which defined quality as health care that is safe, effective, efficient, patient-centered, equitable, and timely.

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