And then there were 59. The Centers for Medicare & Medicaid Services in mid-April unveiled the 27 accountable care organizations that have been approved for the agency's shared savings program. They join 32 Pioneer ACOs as the government's guinea pigs for testing new models of care delivery. The shared savings 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 truly necessary to deliver accountable care. Five of the ACOs will be enrolled in the advanced payment ACO model — aimed at rural and physician-based ACOs — 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.