The ACA's passage in 2010 served as in "shot over the bow" in terms of changing health care's historical business model. The ACA represents the most significant of many regulatory acts that have been enacted to control costs, and improve quality and connectivity within the complex and fragmented health care delivery system. The ACA legislation, which goes into effect over several years, shifts Medicare reimbursement from an activity-based model to a value-based model. Providers will be paid based on performance metrics, including quality outcomes and patient experience ratings, rather than the number of tests of number of visits. Further, providers will be paid a fixed rate of “bundled payment” for an episode of care, regardless of the services provided. The purpose is to encourage the coordination and delivery of appropriate, cost-effective care, risk sharing, and reimbursement across the full range of services and care providers. Different types of health care organizations, including hospitals, medical groups, or consortiums of different providers, may apply to set up an Accountable Care Organization (ACO), which will be paid a set amount per person and be responsible for providing all of the health care for those people who are assigned to or select that ACO. In addition, the American Recovery and Reinvestment Act of 2009 (ARRA) requires all health care providers to implement electronic health records (EHR) and transition from paper-based to electronic medical record systems by 2014 or incur Medicare payment penalties.