Accretive Health 401 North Michigan Avenue Suite 2700 Chicago, IL 60604 March 20, 2011

Exhibit 10.26

EXECUTION VERSION

Accretive Health
000 Xxxxx Xxxxxxxx Xxxxxx
Xxxxx 0000
Xxxxxxx, XX 00000

March 20, 2011

To the Parties Listed on
Schedule A Attached Hereto

Reference is made to that certain Third Amended and Restated Stockholders’ Agreement, dated as of February 22, 2009, by and among Accretive Health, Inc., a Delaware corporation formerly known as Healthcare Services, Inc. (the “Company”), Accretive Investors SBIC, L.P., a Delaware limited partnership, Accretive Investors V, LLC, a Delaware limited liability company, FW Oak Hill Accretive Healthcare Investors, L.P., a Delaware limited partnership, Xxxx Xxxxx, an individual resident of the State of Illinois, and the other parties to the Agreement, as amended from time to time (the “Agreement”).

Whereas, in accordance with Section 6.2(g) of the Agreement, the Company has permitted the parties listed on Schedule A attached hereto (each an “Additional Seller” and together the “Additional Sellers”) to include shares (the “Shares”) of Common Stock in the registration statement for the Underwritten Offering (as defined in the Agreement) contemplated by the Registration Statement on Form S-1 filed with the U.S. Securities and Exchange Commission on March 9, 2011, this letter hereby confirms that each Additional Seller shall be entitled to the benefits, and subject to the obligations, of Sections 6.4 and 6.5 of the Agreement with respect to the Shares as if such Additional Seller were a party to the Agreement and the Shares were “Registrable Securities” under the Agreement.

This letter agreement may be executed in any number of counterpart signature pages, each of which shall be deemed to be an original, and all of which together shall constitute one and the same document. This letter agreement may be executed by exchange of signatures by facsimile.

This letter agreement shall be governed by and construed in accordance with the laws of the State of Delaware, without giving effect to the conflicts of laws principles thereof.

[signature pages follow]

     IN WITNESS WHEREOF, the parties hereto have executed this letter agreement or caused this letter agreement to be executed by their duly authorized representatives, as of the date first written above.

	ACCRETIVE HEALTH, INC.
	By:	/s/ Xxxx Xxxxxx
	Name:   Xxxx Xxxxxx
	Title:   CFO
	ASCENSION HEALTH
	By:	/s/ Xxxxxxx X. Xxxxxxxx
	Name:   Xxxxxxx X. Xxxxxxxx
	Title:   Senior Vice President and Chief Financial Officer
	XXXXXXX X. XXXXXXXXX
	/s/ Xxxxxxx X. Xxxxxxxxx
	XXXXXXXXX IRREVOCABLE CHILDREN’S TRUST
	By:	/s/ Xxxxxxx X. Xxxxxxxxx
	Name:   Xxxxxxx X. Xxxxxxxxx
	Title:   Trustee

	XXXXXXX X. XXXXXXXXX GRANTOR-RETAINED ANNUITY TRUST
	By:	/s/ Xxxxxxx X. Xxxxxxxxx
	Name:   Xxxxxxx X. Xxxxxxxxx
	Title:   Trustee
	XXXXXXX X. XXXXXXXXX GRANTOR-RETAINED ANNUITY TRUST II
	By:	/s/ Xxxxxxx X. Xxxxxxxxx
	Name:   Xxxxxxx X. Xxxxxxxxx
	Title:   Trustee
	THE XXXX X. AND XXXXXX X. XXXX FOUNDATION
	By:	/s/ Xxxx Xxxx
	Name:   Xxxx Xxxx
	Title:   Vice President
	KNIGHT FOUNDATION
	By:	/s/ Xxxx X. XxXxxxxxx
	Name:   Xxxx X. XxXxxxxxx
	Title:   Assistant Secretary

Schedule A

Ascension Health
Xxxxxxx X. Xxxxxxxxx
Xxxxxxxxx Irrevocable Children’s Trust
Xxxxxxx X. Xxxxxxxxx Grantor-Retained Annuity Trust
Xxxxxxx X. Xxxxxxxxx Grantor-Retained Annuity Trust II
The Xxxx X. and Xxxxxx X. Xxxx Foundation
Knight Foundation