Health care in the United States, and by extension in North Carolina, is in a perpetual state of flux. From the Nixon-era predictions of runaway costs to the insurance-anchored efforts of Hillarycare to wide-sweeping reforms of Obamacare, established providers are regularly counseling the next generation on how different medicine will look when they are in practice. The accuracy of some of these predictions aside, one thing is sure: the pace and magnitude of change is palpably different this time. Pushed by both private and public payers to move from fee-for-service to value-based care while striving to meet the Triple Aim of improving patient experience, improving population health, and reducing costs, all arenas of medicine--hospital-based, ambulatory, and public health--are feeling the pressure. At the same time, patients are acting more like consumers, demanding transparency in pricing and increased quality. In this issue of the NCMJ, experts from a broad range of backgrounds and health care organizations discuss the trials and rewards facing providers and health systems as they promise better outcomes and assume greater financial risk in care delivery. The ways that we are striving to meet new payment models--and the successes we are achieving--are as varied as the practices across North Carolina. In the following pages, you will read about the many efforts to implement these new models, both stories of success and a few cautionary tales.