2017 brought a new reality to the U.S. healthcare community. The Medicare Access and CHIP Reimbursement Act, or MACRA, is no longer just the law that repealed the sustainable growth rate. With its Quality Payment Program that defines complex new payment models, MACRA is the machine that is nudging clinicians and practices away from fee-for-service and into value-based healthcare.As the transition begins, many clinicians feel confused as they straddle two payment systems in healthcare delivery. Paul N. Casale, MD, MPH, hosted a Cardiovascular Business roundtable discussion, where participants voiced questions on the minds of many, brainstormed answers and identified new opportunities for the cardiovascular community to lead.