The Affordable Care Act has been hailed as the greatest expansion of social programs in the past fifty years. It’s also the largest single step for healthcare reform since Medicare Part D. It has dominated headlines, conversations, elections, and court dockets for several years. Despite all this, it is just one step in the continuing progress of American health care.

A simplistic way to think about healthcare reform is “what you pay for” versus “how you pay it.” The ACA is primarily targeted at the latter—improving how consumers pay for health care. Most of the reforms in the health care law focus on insurance: the individual mandate, insurance exchanges, new essential health benefits, lifting restrictions on pre-existing conditions, etc. Even less talked-about changes such as the new regulations for mental health and addictions are aimed at changing how insurers must act.

This is all in an effort to help consumers afford the health care they need. Especially pre-ACA, when you could be denied coverage for pre-existing conditions or bankrupted after hitting lifetime insurance limits, it didn’t seem like insurers had your back. Yet in fact, they are your strongest ally in trying to afford medical care while keeping down the cost of service, which is why the ACA has put such a focus into ensuring that all Americans have coverage. Despite constant hand-wringing and attempts to defund the ACA, it’s not going anywhere. Thus, barring the politically nigh-impossible move to a single-payer system, Obamacare is likely the last large change for a while. Over the next few years, the last several pieces will fall into place to help stabilize the new insurance market (think the “three R’s”). By no means, however, does this mean the end of healthcare reform.

The next phase in reforms shifts back to the “what you pay for” dilemma. Not only are American health care costs high, they can vary wildly. The ACA’s role here is decidedly long-term, highlighting the evidence and quality-based approach needed to change not only the practices, but the mindset of the industry. How, for instance, do we effectively implement health information technology? How do we manage end-of-life and palliative care? Can we find a more cost-effective model than fee-for-service? How do we unify treatment best practices?

What the ACA has done is put tools in place to find the answers to these questions, tools such as The Patient-Centered Outcomes Research Institute, “a way to support research that will inform patients, doctors and the public about the comparative effectiveness of various treatments.” The institute is the central hub in funding research efforts across the county trying to find a way to keep patient costs low. Additionally, trial programs for Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs) are underway to test new models of patient care, curtailing costs by organizing treatment.

Other problems point to answers in education. Oregon recently documented that their Medicaid expansion led to higher emergency room visits, suggesting a need to educate the newly-insured. Similarly, the government has made a push to find a way to supply primary care providers to meet the new demand.

Many of these answers could be years in the making, especially when trying to parse their impact on health spending. The ACA has given the healthcare community a platform from which to examine itself and correct its future. From here on out, the changes will be piecemeal, coming in the form of best-practices in lieu of sweeping legislation. Often they won’t capture headlines, but this trickle of tinkering and tweaks will become the new face of the health reform movement.