Hallmarks of the post-Affordable Care Act era are a significant shift toward value-based and risk-sharing contracts. The leader of the reimbursement pack, the Centers for Medicare & Medicaid Services (CMS), has moved aggressively in the direction of value based reimbursement arrangements with providers. To provide some perspective, in 2011, no Medicare payments were delivered under risk arrangements. In less than five years, Medicare has achieved its target of making 30 percent of payments risk-based and it is on track to meet its goal of 50 percent by 2018.