After nearly a decade of national and local pressure to advance towards value based payment models focused on care of a population, what have we learned?  While the push to value based care continues, the landscape has not moved as quickly as many expected.     Understanding this landscape requires looking at both the national policy level and exploring the experiences of one of the most successful Medicare ACOs in the country. In this talk, Dr Whitfill will review both of these topics and highlight how new models of technology and care are required to succeed in a value based model.