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Until now, much of the dialogue surrounding pay for performance (P4P) has focused on big-picture issues: How will P4P change the healthcare system? Will quality measures improve medical outcomes? How long will it take Medicare to transition to a P4P system? But as P4P moves from an idea to a reality-more than half of all health maintenance organizations now use P4P contracts, according to the Agency for Healthcare Research and Quality-you must prepare to deal with the day-to-day questions: How can you align P4P with your culture? How will physicians respond to P4P incentives? What is the best way to distribute P4P revenue?