The administration has been pushing very hard on the Accountable Care Organization (ACO) model, which is a somewhat nebulous concept, but which is broadly supposed to save money by streamlining services and coordinating care. It's one of the centerpieces that pro-Obamacare wonks point to as a real source of cost savings and improved services. Exhibits A and B are usually Mayo and the Cleveland Clinic, with a few others occasionally thrown in.

However, when the administration rolled out its new ACO program last March, the poster children declined to participate, and an organization that represents large provider groups sent a letter to the Center for Medicare and Medicaid Services indicating that most of their members would not participate. The reporting requirements, and the financial penalties for ACOs that didn't achieve savings, were simply too onerous.

In response, in May the administration created a new ACO program called Pioneer for "mature ACOs". Unfortunately, it looks like the poster children have again refused to become a part of the demonstration project