The Syracuse market is hesitant to take on value-based contracting, preferring to stay a fee-for-service market, but its integrated delivery networks and their respective clinically integrated are poised to make the transition. IDNs are expanding their clinical capabilities and competing for patients in affluent suburban areas where new facilities and medical offices are opening at a rapid pace. Physicians, in turn, are aligning with IDNs through super clinically integrated networks that include multiple physician groups and health systems. Excellus BlueCross BlueShield operates a shared-savings program known as the Accountable Cost and Quality Agreement program that is a vehicle for value-based contracts in the market and statewide. All payers will benefit from the increased scale, outpatient services, and care-coordination expertise offered by providers. Look for the COVID-19 pandemic to accelerate the transition to value-based contracting as a way to stabilize budgets and drive innovation in this developing market.