Wendell nails it.
The real bottom line would be a business plan for the ACO, including the all-important projections model in a spreadsheet that identifies capital costs, recurring and non-recurring costs, with input values that allow the potential participants to model different return rates and overhead percentages.
The second part would be how many of the big-$$$ EMRs and the implementers would enter into a implementation contract where *ANY* initial and/or long-term cost overruns come out of their fees.
When the tasks are precisely defined we will do fixed-price contracts, because we are confident of our chosen tools and people. We offered just such an approach to a regional hospital that wanted to use AC at scale, but that was derailed after a big-@$$ EMR company got involved. I suspect someone got 'bought'.
Doctors are increasingly looking for win-win, or they are walking away, which is a good thing. the NYT article is another example.
