The healthcare system in the United States is on a trajectory toward insolvency. The budgetary constraints of federal and state programs are compressing reimbursement to providers. In addition, the consolidation of commercial payors has increased their market power and led to minimal revenue growth for providers. As a result, the operating margins of integrated healthcare systems across the country are under pressure. Without structural change, the current configuration of physician organizations (both independent and employed) may not be sustainable. This presentation explores how reimbursement is transitioning from payments based on fee-for-service (FFS) (volume) to a more value-based system as well as considerations for joining an accountable care organization.