The evolving healthcare landscape has created a wealth of fresh opportunities for payers. There is a sense of urgency for payers in leadership roles to leverage technology and successfully transition to a value-driven healthcare system that rewards top performers and high quality standards. Passage of the Patient Protection and Affordable Care Act (PPACA) quickly changed many aspects of payers' business with higher costs, new oversight, more competition and a longer-term promise of millions of new members. Since healthcare insurance reform became law, opponents have vowed changes, if not its outright repeal. While it may be tempting to take as little action as possible and hope that the 2010 mid-term election or 2012 general election will make this all go away, the reality is that repeal is not a likely possibility.