The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act (ACA), was passed in 2010. It is a mammoth piece of legislation that is most well-known for its attempt to reduce the uninsured population and to provide health insurance subsidies for the majority of citizens. Some of its lesser publicized provisions, however, added new value-based reimbursement models discussed earlier in the chapter (namely, bundled payments and accountable care organizations), and created the four original value-based programs:

• Hospital Value-Based Purchasing Program (HVBP)
• Hospital Readmission Reduction Program (HRRP)
• Hospital Acquired Conditions Reduction Program (HAC)
• Value Modifier Program (VM)

These programs will be discussed in detail in Chapter 6, Measuring Healthcare Quality.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) initiated the Quality Payment Program, composed of both the Alternative Payment Models (APM) program and the Merit-Based Incentive Payments System (MIPS). Both programs, which will be discussed in more detail in the Measuring Provider Performance chapter, moved the US healthcare system further away from FFS reimbursement toward value-based reimbursement.