A national survey by the National Association of ACOs finds leaders are concerned about recovering their investments and pressure to share in losses. ACOs bristled at the assertion that up-side only shared savings arrangements are just bonuses. One survey respondent said, “The investment risk is substantial (in our case $2.5 million per year) with no guarantee of any return. I call that risk.” 43% of respondents said they would definitely or likely leave Medicare if forced to accept downside-risk arrangements. Our survey earlier this year of ACOs in CT found similar themes – concerns about recovering costs, modest savings, and an uncertain future. Both surveys include recommendations for policymakers and payers to promote success.