Abstract
Pay for performance cannot consist of a one-size-fits-all approach. Variation in quality and cost of care is best measured using a single "value" (quality/cost) score that is decomposed into component cost and quality for every health care encounter type. Economic incentives must be enough to focus the provider's attention on each score part. Tools exist that improve the overall "value" of health care. We need agreement on an overall pay for performance approach together with a toolbox (not an approved list) of scientifically validated tools that payers, providers, and consumers can choose to build the incentives needed for pay for performance.