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This report synthesizes findings and lessons from case studies of four diverse health care organizations participating in the Brookings–Dartmouth ACO Pilot Program, launched in 2009 to support selected provider groups that are collaborating with private payers to form accountable care organizations (ACOs). The organizations are: HealthCare Partners, a medical group/independent practice association (IPA) in Los Angeles, Calif.; Monarch HealthCare, an IPA in Orange County, Calif.; Norton Healthcare, an integrated delivery system in Louisville, Ky.; and Tucson Medical Center, a community hospital working with independent provider groups in Tucson, Ariz. Each has agreed to take responsibility for overall quality and costs of care for their patients, and each has a committed private payer partner and sufficient patient population to support comprehensive care coordination and performance measurement. The strategies they have adopted to develop internal capabilities and external partnerships can inform providers, payers, and policymakers about the process of ACO formation.     