 BACKGROUND Engaged patients have been referred to as ...the blockbuster drugs of the 21st century. Under the Affordable Care Act ACA, Accountable Care Organizations ACOs are required to engage patients. The specific question we will address is: Do patients receiving care from ACO practices with highly developed patient activation and engagement PAE activities achieve better patient reported health outcomes, report better experiences of care, and have better selected clinical measures blood pressure, hemoglobin levels, and LDL-C compared to patients receiving care from ACO practices with less developed PAE initiatives? We plan to capitalize on the natural occurring variation in degree of implementing PAE activities. 