A great deal of the improvement desired in the health system is predicated on getting patients and providers to change behavior. Positive and negative incentives for such change are now widely used by health plans, payers and regulators. The Centers for Medicare and Medicaid Services has initiated several programs which reward or punish almost every type of provider for certain occurrences, such as hospital readmissions, or in regard to quality of care or efficiency measures. A report from the Health Care Incentives Improvement Institute discusses the state of incentives. (HCIII Report) The authors begin with the perspective that while incentives can be valuable in getting care improvement, they are not easy to apply to complex tasks and systems and often result in worse performance, because the intended recipient becomes demotivated. They note that financial rewards can be perceived as manipulative and that designing rewards that affect a person’s sense of autonomy and purpose may be more effective. While acknowledging that the current predominant fee-for-service system may be a source of cost and appropriate care problems, they don’t believe that payment reform alone will be sufficient to change provider or patient behavior. They believe the focus should be on activating both patients and providers to want to achieve good health and be involved in appropriate care. Shared decision-making based on full and accurate information is a core to their suggested solution. The report is interesting and makes a certain sense, but has little in the way of specifics or different ideas that can actually be implemented.