The current fee-for-service system of paying for health care emphasizes volume and complexity, and often discourages attempts to improve effectiveness and efficiency. This brief discusses several policies that could begin to move away from the adverse incentives embedded in the current system to incentives that encourage better care and better value. The authors believe that U.S. health care would be better and more efficient if the system as a whole functioned the way top-performing providers do, with greater accountability for specific populations and for the totality of care delivered. They argue that the Medicare program is an ideal starting point for delivery system reform.