"CMMI has piloted a number of demonstrations on bundled payments, hospital payments, and accountable care, and MACRA moves Medicare physician payment towards a value structure. But we aren’t there yet. So far, most demonstrations have not made significant changes to health care spending. Participants have had little downside risk while receiving additional bonuses for meeting certain quality and savings targets. While this approach is key to drawing in participants at the outset, it shows little will among providers to risk profits."