This resource describes a national survey of ACOs about initiatives to address serious illness, as well as follow-up case studies.

• Only 8–21 percent of ACOs have widely implemented serious illness initiatives such as advance care planning or home-based palliative care.
• The authors selected six ACOs with successful programs for case studies and interviewed fifty-three leaders and front-line personnel.
• Common themes include the need for up-front investment to build serious illness infrastructure and workforce; supporting the business case for organizational buy-in; and how ACO contract specifications affect savings.