Since its passage in 2010, the Patient Protection and Affordable Care Act has continued to receive considerable attention in the lay press and health policy literature, and appropriately so.1 Despite its name, the Affordable Care Act’s primary emphasis is on patient access to health insurance coverage and, by extension, health care services. In contrast, the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) outlines a fundamental shift in how US federal health programs will pay for health care services. While MACRA has not been included in the colloquial health care reform discussion, it has the potential to profoundly alter the delivery of health care services in the United States for the foreseeable future. Simply put, MACRA provides the roadmap for our health system’s transition from volume-based to value-based payment and care.