It will only be a requirement if all the physicians drink the Kool-Aid. From what I've read, both this and the ACO shift the risk from the insurance company to the doctor. They don't pay you enough as it is, now they want to to take on risk, which normally is illegal for you to do. For instance, if you had tried to offer a "membership plan" you'd have to be very careful because risk is a province of insurance and you would be charged with providing insurance without a license.
