The Patient Protection and Affordable Care Act of 2010 was passed to increase access to health care, decrease growth in health care costs, and improve the quality of care. Accountable Care Organizations (ACOs), bundled payments, medical homes, and other payment reform initiatives are major initiatives of the bill and will effect provision of primary and specialty medical care. The effect of these initiatives on the field of oncology, and specifically radiation oncology, is unclear. In the session, we will review various payment reform initiatives; discuss their potential impact, both intended and unintended, on quality and cost growth in radiation oncology; and describe opportunities for the field of radiation oncology in light of health reform. At the conclusion of this activity, the learner will be able to do the following: 1. Illustrate a basic understanding of ACOs, bundled payments, medical homes and other payment reform initiatives. 2. Describe the impact of the initiatives on radiation oncology and opportunities for radiation oncologists to play a role. 3. Explain how the various branches of government impact nascent efforts to change delivery and payment systems.