In 2011, the Obama administration settled on 32 health care systems, scattered across the country, to lead the Affordable Care Act's most ambitious cost-control effort. These hospitals and doctors would move Medicare away from paying doctors for volume—and toward paying for value. The group was given a name that has stuck: the pioneers. When I asked the Advisory Board's Chas Roades to describe the group, he called them "The Lewis and Clarks of hospitals." "They're really exploring new territory," says Roades, who oversees research for the hospital consulting firm. These Lewis and Clarks have-as many pioneers do, when faced with new territory-hit some choppy water. A year into their endeavor, they are demanding changes and delays to some of the act's programs central tenants.