RT Journal Article SR Electronic T1 A Sea Change in Medicine JF North Carolina Medical Journal JO N C Med J FD North Carolina Institute of Medicine SP 261 OP 264 DO 10.18043/ncm.77.4.261 VO 77 IS 4 A1 Bruch, Richard YR 2016 UL http://www.ncmedicaljournal.com/content/77/4/261.abstract AB The Patient Protection and Affordable Care Act and the Triple Aim are driving a shift toward value-based care. Significant financial risk is being transferred from commercial insurers and government payers to hospital systems and independent physician groups. Medicare has developed bundled payment programs, but legislative barriers still impede the implementation of value-based health care.