It is complicated. The healthcare system is controlled by many laws and systems of payment that do not allow changes to the payment systems of providers (hospitals, physicians, outpatient centers, etc.) with the payers (Medicare, Commercial Insurance Companies, etc.). In addition, each of the payers has a different way of paying the providers. Currently, the majority of care is paid based on what is done per patient. The reformed system may pay based on the management of total care for a population. However, it takes time to make this type of change. There is also consideration to move to evidence based care which would change many of the current treatments for patients. This is a big change that worries many people. Small steps in reform allow providers and payers to assure that patients are receiving the care they need. As new models are tested and demonstrate that they improve care and save money, we will see them implemented throughout the country. This will be a difficult journey but one that needs to occur to assure patients have access to the care they need.