As Connecticut's healthcare industry experiments with new models of care, getting everyone to buy into the changes isn't always easy. The contractual model hit the market in 2010, but CJRI didn't get its first contract inked until a few months ago when Farmington insurer ConnectiCare agreed to a deal. CJRI's experience is an example of how challenging—and slow—implementing changes to a health care system can be. The bundled payment arrangement established by CJRI—called the Step Ahead Plan—is a collaborative effort among St. Francis Hospital and Medical Center, The Connecticut Joint Replacement Surgeons, and Woodland Anesthesiology Associates. As part of an integrated continuum of care, all three providers are responsible for guiding patients through the entire hip and knee replacement surgery until they are discharged from the hospital.