Challenging reimbursement environments and regulatory changes under the Affordable Care Act (ACA) are transforming provider reimbursements with an increasing focus on value and pay for performance (P4P), rather than volume. Yet, providers are struggling to implement the level of clinical and organizational integration required to simultaneously reduce costs and improve quality, and also build a framework for population health management. As healthcare transformation unfolds, sustainable payment models must balance payment and productivity with quality and outcomes.