Bundled payment policy is at a crossroads. Over the last decade, participants in several nationwide models of bundled payments have driven practice changes and produced savings for medical and surgical episodes compared with usual care without bundled payments. [1][2][3][4] There is no evidence that bundled payments have induced procedural volume increases, as was a prior concern. 5 Bundled payments also appear to complement mechanisms for quality improvements and cost savings in population-based models such as accountable care organizations. 6 However, it has been challenging in bundled payment models to balance financial incentives for participants with savings for Medicare. This is evident in Bundled Payments for Care Improvement Advanced (BPCI Advanced), in which Medicare recently adjusted program rules to mitigate its financial losses and preserve program viability. These post hoc changes transferred some savings earned by participants back to Medicare, prompting some participants to exit the program. Separately, the evidence has been mixed about how bundled payment programs affect equity and safetynet organizations. Given these benefits and challenges, it is now critical to define the role for bundled payments and other specialty-focused payment models within a comprehensive alternative payment model strategy.The report by Sashikumar and colleagues in this issue of JAMA brings new results into this policy context. 7 Using claims data from 694 participating hospitals and a differencein-differences methodology, the authors analyzed data from the BPCI Advanced initiative (from October 1, 2018, through December 31, 2019) and found that the program was associated with an estimated $75 million decrease in gross spending, but after distribution of financial bonuses, it was also associated with an estimated $279 million increase in net spending for Medicare. 7 Hospitals that served larger proportions of historically marginalized populations earned disproportionately large bonuses, in stark contrast to analyses of other value-based programs. 8 The authors of this study used a contemporary approach to examine a timely policy topic and adopted a rigorous approach that included several sensitivity analyses and a focus on safety-net organizations. The work of replicating Medicare approaches to calculate financial benchmarks (called target prices in bundled payment programs) was critical for assessing net savings as an outcome. Another important contribution was the effort to identify and distinguish between target price (what spending amounts trigger financial bonuses) and counterfactual episode spending (what spend-