It was October 20, 2011, a big day for Don Berwick and his team at the Centers for Medicare and Medicaid Services (CMS) in Washington, D.C., and a month before he announced his long-anticipated departure from the agency. They were unveiling the Final Rule for the Medicare Shared Savings Program. The setup and the message were classic Berwick: graciously recognizing others for their work, focusing on the patient impact, and insisting that health care professionals want to do the best job possible. But the ACO model also reflects his belief that simply imploring people to do a better job won't work. In his view, systems must be redesigned and financial incentives revised to ensure that patients receive services quickly, seamlessly, safely, less expensively, and as full partners with their clinicians.