The Affordable Care Act (ACA) is changing medical delivery and funding streams, with an impact on business models, institutional and facility planning, capital projects, asset utilization, and strategic positioning for healthcare facilities. Meeting the challenge of delivering high-quality, low-cost healthcare will require determining the fee-for-value proposition behind these changes—how the cost of changing healthcare services affects quality outcomes, and ways to measure these outcomes, says Anthony Roesch, director of healthcare consulting for HOK in New York. Healthcare organizations will increasingly look to mergers and acquisitions, as well as new partnerships, to limit costs and prolong the life of aging facilities, as the ACA forces them to shift from a fee-for-service financing model to a quality-of-care, outcomes-based model. Rather than all treatment being delivered at the hub, or hospital setting, the new model leverages services available in the community to cover an entire region or state.