Formulary decision makers at hospitals participating in ACOs say that they are struggling to understand and meet multiple goals of value and quality. Moreover, ACO physicians have a clear expectation that pharma will find a role in suporting the new value-based healthcare system. These key decision-makers believe pharma can help them engage patients and provide solutions to meet key measures. This reports discusses how ACOs are faring in improving quality, and the types of solutions pharma should offer.