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156 www.ccmjournal.org January 2018 • Volume 46 • Number 1 driving a CCO interaction is to target the improved health of ICU survivors, the role of each discipline will vary based on the unique needs of the patients and families served. Thus, “both” the core, macrolevel aspects of the CCO as well as those more detailed must be considered. If CCOs, for example, were to really take on the work of population health in a vertical integration frame, there would need to be preventive programming around alcohol and drug-related injuries to prevent ICU admissions involving cases of substance abuse. Further, the suggestion that intensivists have the skills and expertise necessary to manage this broad range of services using a public health lens is simply without merit. Finally, the authors highlight that a CCO is “by definition, the model of an Accountable Care Organization (ACO).” (6) The value behind vertical integration strategies, by virtue of ACOs, has already been demonstrated from a quality perspective at “all points” throughout the healthcare continuum. So, the question is why would we want to embed a micro ACO named a CCO within an existing ACO model? The contribution of the CCO for a segment of this continuum adds an administrative burden without clear and demonstrable outcomes. If the CCO maintains responsibility for the overall coordination of care, including that for other service providers, the relationship with the more macrolevel ACO becomes unclear and perhaps redundant when it comes to human and technical resources. Every idea, even potentially brilliant ones, need to challenged and vetted before acceptance and adoption. The CCO model presented by Leung et al (6) may be the prevailing paradigm in the future, but at the moment, there are several caveats to consider prior to discussing and recommending the model to hospital or health system leadership. In future endeavors, we urge physician leaders to use empirical evidence to support basic science, clinical science, and operational research before making recommendations for change. Additionally, when reorganizing or developing new operational structures, roles, or programs, it is essential to assure alignment with shared strategies, objectives, and tactics with the overall system of care. The development of new care models requires more than the arrangement of boxes on an organizational chart. Within healthcare, the implications of incomplete planning, piloting, measurement, and evaluation cascade far beyond the organization, CCO, and even ACO, they directly impact the lives of the patients, families, and communities we serve.