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Across the country, doctors, hospitals and insurers are forming new health care entities to increase the efficiency and quality of health care, and lower the cost of it. Called accountable care organizations, these groups are gaining ground, even though critics consider them a repackaging of HMOs some of which have given managed care a bad name.

An ACO is a group of health care providers such as doctors, hospitals and others, including insurance companies, who agree to work together to provide overall care to their patients. Those providers are accountable for the quality and cost of that care. If they reduce costs while improving patient care, they share in the savings. If they dont deliver, they may risk losing money.

While the idea has many proponents, critics are concerned about the creation of large health care groups that could have too much influence over physician decisions. That could backfire and ultimately result in increased health care costs.

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Hospitals controlling and running ACOs that makes our members very nervous, said Francisco Silva, vice president and general counsel for the California Medical Association based in Sacramento.Its absolutely important that ACOs are physician led. The ACO model can be a very good thing, but it needs to be done carefully as a collaborative effort, he said. We learned from the HMO experience. There were a lot of stories of folks being denied care.

But there is increasing support for changing the way health care is delivered and making all parties in the system accountable for the cost.

Right now Id say there is a growing consensus that accountable care is the future of health care, said David Muhlestein, an analyst with Leavitt Partners, a Salt Lake City-based health care analyst firm.

But a clear definition an ACO has yet to be determined, he added.

Affordable care organizations are emerging both through Medicare and in the private sector. The Affordable Care Act required the Centers for Medicare and Medicaid Services to develop an ACO program, which, as of July 9, has 154 ACOs serving 2.4 million Medicare patients, according to the Department of Health and Human Services. These ACOs must meet patient care standards based on 33 quality measures.

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New health care groups look to cut costs and improve quality

Allison Miller was among the nurses and doctors giving free care in July in the Los Angeles area.

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Editor's note: Aaron E. Carroll is an associate professor and vice chairman of health policy and outcomes research in the Department of Pediatrics at the Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- Unless you've been living under a rock, you know people are concerned about the deficit. Or at least they say they are. You'd also have to be willfully ignoring everything around you not to know that health care spending is a significant cause, if not the cause, of our long-term fiscal problems.

The narrative that seems to be going around Washington argues that there are two schools of thought about how to improve our financial outlook. One side wants to cut spending. The other side wants to increase taxes. Or, so it goes.

I was out to dinner on Saturday night with a friend who is rather pessimistic about compromise in our government. He believes that the chances for passing anything that might reduce spending on health care in the future are near zero. There's just one problem with his outlook. We've already passed a law that does a great deal to reduce future health care spending.

Aaron E. Carroll

I have argued many times that I don't think the Affordable Care Act does enough to contain costs. I still believe that's true. But let's not ignore the fact that it does a lot. More, in fact, than anything else passed by Congress and signed into law by a president in quite some time.

Right off the bat, we need to remember that the Affordable Care Act makes significant cuts to future Medicare spending. Reductions in overpayments for Medicare Advantage constitute almost $140 billion in savings over a decade. Changes in the fee-for-service reimbursement schedule add up to almost $200 billion. That's an enormous amount of money, so large that it scared many people into thinking that Medicare would be severely curtailed. Running against Medicare cuts helped sweep the Republicans into power in the House of Representatives in 2010. Often, such arguments came from the same people now decrying the Affordable Care Act for not cutting health care spending enough.

But that's just the tip of the iceberg. There are lots of other payment reforms (PDF) that should "bend the curve" for Medicare in the next decade. Hospitals will be punished for re-admissions for certain conditions. This is expected to save $8.2 billion. Refusing payments for hospital-acquired conditions should save another $3.2 billion. Accountable care organizations, for better or for worse, are expected to save almost $5 billion in the first eight years as well.

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Opinion: Another look at Obamacare

President Barack Obama is warning Florida retirees that Republican challenger Mitt Romney would undercut the new health care law and alter Medicare, a play for voters in one of the nation's top swing states.

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Obama, Romney tangle on health care, jobs

The Supreme Court decision upholding the 2010 health care law has left more American voters feeling "worried" than "reassured" about their personal health care situation. Meanwhile, majorities still want at least part of the health care law repealed.

The latest Fox News poll, released Thursday, shows 58 percent of voters think the Affordable Care Act needs to be changed and Congress should keep at it. Forty percent disagree: It's done and lawmakers should "move on."

Not surprisingly, most Republicans (84 percent) think lawmakers should keep working on the law. A 53-percent majority of independents agree -- as do 35 percent of Democrats.

Overall, a 57-percent majority of voters would like Congress to repeal at least part of the health care law: 29 percent want complete repeal and another 28 percent favor repealing parts of it.

That's down slightly from a high of 61 percent wanting to repeal at least part of the law in January 2011. Since 2010, when this question was first asked, a majority has favored repealing at least some of the law.

Of the four voters in ten who want Congress to keep or expand the law, 18 percent favor expanding it, while 22 percent say leave it as is. That's a new high for the number favoring keeping the law in its current form, up from the previous high of 16 percent (in both April 2011 and December 2010).

Almost all Republicans want Congress to repeal all (57 percent) or parts of the health care law (30 percent).

Two-thirds of Democrats want the law expanded (29 percent) or left as-is (36 percent). One in four Democrats favors repealing parts of the law (24 percent).

Among independents, a 57-percent majority thinks at least some of the law should be repealed, while 39 percent favor keeping or expanding the law.

The Supreme Court ruled most of the 2010 health care law constitutional on June 28.

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Voters 'Worried' About Health Care After Ruling

By MARY SHEDDEN | The Tampa Tribune Published: July 20, 2012 Updated: July 20, 2012 - 12:00 AM

Florida's governor has no plans to expand health care for the state's poor, but Hillsborough County health advocates say they still plan to help struggling uninsured residents.

Last month, the U.S. Supreme Court ruled that states can decide whether to implement the federal Affordable Care Act's expansion of Medicaid for uninsured residents, many between the ages of 19 and 64.

Gov. Rick Scott, a staunch opponent of the Affordable Care Act, swiftly announced that Florida will not participate.

However, more than 10,000 county residents living at or below the federal poverty line already participate in a 20-year-old free local health care plan similar to what the expansion would offer.

Advisors to the Hillsborough County Health Care Plan said Thursday they are moving forward with plans to reach even more eligible participants.

"There are people who are clearly eligible for our plan and don't know about it," said Gene Earley, the county director of health care services.

Thursday's meeting provided the first clue about how many local adults are eligible but missing out on the free preventive and acute medical care and prescription drug assistance. Preliminary reviews of census and Medicaid rolls show that more than 40,000 eligible and uninsured residents are being missed.

Who they are, where they live and each person's specific medical needs will be identified within three months as part of an education and recruitment strategic plan, Earley said.

Since voters backed its creation in 1991, a half-cent county sales tax and trust fund now more than $94 million and $47.3 million, respectively have covered the plan's costs. In 2011, expenses totaled $72.5 million.

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County has free health plan for poor

COEUR d'ALENE - Business consultants have been facing "a lot of nervous business owners" following the upholding of the new health care reform, said Lance Fenton, CPA at Cooper Norman.

Speaking on a health care reform panel on Thursday morning at North Idaho College, Fenton said most companies worry how they'll be impacted financially.

"We're trying to put their minds at ease," Fenton said.

Thursday morning's forum on the Affordable Care Act, presented by PacificSource Health Plans, glossed over the law's requirements for businesses.

Companies with at least 50 employees will have to provide workers with health care coverage. Or, they can pay a $2,000 penalty per employee they don't insure, who will instead seek coverage through health insurance exchanges provided by the state or federal government.

Companies of any size must educate their employees about their insurance options.

The Congressional Budget Office has projected that under the new act, the number of uninsured will drop from 50 million today to 22 million by 2016.

Panelist Stephen Cilley, CEO of Ataraxis, Inc., said he didn't think many Idaho businesses would be dramatically affected by the new law.

"Most businesses in Idaho aren't over 50 people," said Cilley, whose Boise company handles employee services for businesses.

But panelist Shelli Stayner, with Mercer human resource consultant, said there is debate among small employers over whether to rely on a state insurance exchange, if one is created.

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Health care worries businesses