CMS has indicated that by 2018, its goal is to have 50% of Medicare Fee for Service Payments linked to Alternative Payment Models and to have 90% of those payments linked to quality. To accomplish this goal, CMS has introduced a number of value-based reimbursement and quality programs, including the Medicare Shared Savings Program, the Next Generation ACO Model, the Bundled Payment for Care Initiative, and most recently, the Comprehensive Care Joint Replacement Program, a program which for the first time makes participation mandatory for many hospitals. Commercial payers are also following the CMS lead with a variety of Alternative Payment Programs.