n 2013 the Center for Medicare and Medicaid Innovation (CMMI), a component of CMS, began offering enrollment in two optional programs. The programs, Bundled Payment for Care Improvement (BPCI) Initiative and the Accountable Care Organization (ACO)/Medicare Shared Savings Program (MSSP), were attractive to Duke and Colorado. Each posed specific risks and benefits, which ultimately resulted in different choices. Overall, each organization is dedicated to linking clinical innovations to payment reforms that encouraged a value-based system – one that rewards based on quality, outcomes, and reducing inefficiencies, such as preventable readmissions – as opposed to a volume-based system that is based on number of tests, procedures, etc