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It's OK does zoloft make ocd worse Medicare pays pioneers differently. If an ACO saves money, it can split the savings with Medicare -- as long as it hits 33 quality and performance measures -- or share in any losses. As a result, the five Boston-area health care systems have stopped scrapping for market share. Instead of filling hospital beds, the ACOs are working to reinvent patient care to reduce barriers rife in the current fee-for-service system, including widely varying experiences and issues that older patients face in skilled nursing facilities (SNF), home health services, rehabilitation hospitals and other sub-acute settings. ACOs are one of the ways Medicare, commercial and other payers nationwide are trying to make care better and less expensive.