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CHI Health and Nebraska Health Network, the alliance of Nebraska Medicine and Methodist Health System, are pushing value-based care delivery and payment models in the Omaha market by aligning with large numbers of local physicians and with commercial insurers to form accountable care organizations. But physicians are the first providers to take on risk through “total cost of care” contracts and could drive the adoption of more risk-based payment arrangements. Care coordination is also on the rise in the public sector with the implementation of the state's new new managed Medicaid system, which integrates medical, behavioral health, and pharmacy services. Votes to expand Medicaid in Nebraska under the Affordable Care Act via ballot initiative will give health plans, including Centene, UnitedHealthcare, and WellCare, the opportunity to increase enrollment by an estimated 45,000 members next year.