Three months after its projected arrival date — and two years after garnering much of the health care industry's attention as a key cost and quality pillar of the Affordable Care Act — the shared savings accountable care organization program developed by the Centers for Medicare & Medicaid Services is finally underway, CMS announced yesterday. All told, 27 ACOs are participating in the shared savings initiative, joining 32 organizations already engaged in the Pioneer ACO program for early adopters.

Beyond the numbers, the announcement contains a couple of interesting developments that suggest CMS is trying to respond to criticisms that its ACO initiatives expect too much of participants, especially in terms of the IT, financial and organizational components that many health care experts say are necessary to truly deliver accountable care — a topic H&HN Daily contributor John Glaser touched on yesterday.

Five of the ACOs will be enrolled in the advanced payment ACO model — aimed at rural and physician-based ACOs who will be able to access prospective savings in advance to support their efforts. And nine of the organizations will be working with Collaborative Health Systems — a subsidiary of Medicare Advantage partner Universal American that will help ACOs leverage many of the technical and structural capabilities needed to function in the program.

I talked this morning to Jim Korry, senior vice president of CHS, who said the company will be working with physician groups, physician hospital organizations, multispecialty practices and other entities to offer everything from IT and care management assistance to financial and reporting infrastructure.

"I think it's CMS's attempt to try and support the coordination of care and the Triple Aim," Korry said. "…When we enter into a partnership with a medical group, we do a deep dive to where the augmentation should be applied."

Universal American launched CHS, Korry said, shortly after the shared savings program was launched, figuring its experience working with Medicare and the target population would be of use to ACOs. It plans to start with the nine organizations it will be working with in the shared savings program, but may ultimately get involved in some of the private ACO models that providers, insurers and employers are currently formulating outside of the formal CMS initiatives, Korry said.

Send your thoughts on the shared savings program — and whether providers will be able to harness the IT, financial and clinical resources needed to meet the program's lofty goals — to