2017 was a year of tremendous uncertainty for healthcare providers. After spending the previous several years adjusting to the realities of and complying with The Affordable Care Act (ACA), the provider community watched President Trump take office last January and install Tom Price as Secretary of the U.S. Department of Health and Human Services (HHS) with a promise to aggressively pursue the repeal of major elements of the law. By the end of the year, however, those legislative efforts had ended in a series of unsuccessful votes and former HHS deputy secretary and pharmaceutical industry executive Alex Azar had been nominated to replace Price as the nation’s top health official. Unsurprisingly, this left many providers more uncertain than ever about what to expect from Washington, D.C. in 2018. In response, under the new leadership of Secretary Azar, the Administration has pivoted from last year’s efforts to repeal the ACA and towards four new priorities for 2018: (1) combating the opioid crisis; (2) bringing down the high price of prescription drugs; (3) addressing the cost and availability of insurance; and (4) the value-based transformation of America’s healthcare system. For providers, the Administration’s endorsement of the transition to a value-based system is without question the most significant of these new goals, especially given the ACA’s overlap with MACRA and other value-based programs such as accountable care organizations (ACOs).