This Urban Institute policy paper, funded by the Robert Wood Johnson Foundation, provides an update on the Medicare Shared Savings Program Accountable Care Organizations (ACOs) as well as ACO activities in the private sector. The paper provides an overview of ACOs, the key complaints about the Centers for Medicare & Medicaid Services’ proposed regulations for the Medicare ACO and their resolution in the final regulations, and the status of adoption of this new model for delivering health care by both Medicare and private health insurance plans.