There is a strong consensus among policymakers that US health care costs are unsustainable. In 2011, total health care spending in the United States reached $2.7 trillion, representing 17.9% of the gross domestic product and averaging $8680 per person. Although American health care costs are much higher than those of other nations, health care outcomes in the United States are no better and often are worse by all measures. Overall, policymakers of all stripes have concluded that the US health care system provides poor value. Accountable Care Organizations (ACOs) are proposed to increase value by coordinating care, reducing costs, and measuring quality of care. In this article, I will describe ACOs and discuss how they may impact dermatologists and the care of patients with skin disease.