As the cost of health care continues to rise, government and commercial payors are implementing strategies as a means of reducing the overall expenditure of health care dollars. The largest savings will be not just in more cost-effective treatments but in strategies that can avoid the need for treatments in the first place. Although the savings from popular payor reform strategies like bundled payments are tied to the initiation of the clinical episode, population health programs utilize a variety of tactics to decrease the need for health care utilization overall. However, the payor reform landscape is seeing some convergence of strategies as varying tactics can be complimentary. Given the dramatic rise in expenditures on spine surgery and related services, spine surgeons should understand how population health and other efforts will inevitably influence spine health care delivery going forward.