The ACA has created a model shift in healthcare from a volume-based provision of care and to a quality/value-based provision care. This payment model rewards lower cost and higher quality care. In the beginning of 2015, the department of Health and Human Services was shifting half of their spending not devoted to managed care into accountable care, bundle payments and contracts that reward quality performance and better cost control. This model is not only applicable to Medicare and Medicaid rather to the whole insurance payer models. Many of the largest health systems and insurers, such as Aetna, Ascension, Trinity Health, are working together with a goal of shifting 75% of their business contracts with incentives for quality and lower-cost