How we deliver medical care and pay physicians in the U.S. creates incentives that influence both the kind and amount of care delivered and the proportion of doctors who choose given specialties—often in ways that lead to undesired outcomes. For health care reform that lowers costs, improves quality, and increases access to needed preventive and primary care, we must change these incentives. That will require accurately measuring quality in care, understanding what motivates physicians, and effectively aligning those motivations with high-quality care. This month’s authors explore promising developments in and pitfalls of current attempts to conceptualize and enact these new rewards.