A growing number of health care purchasers are looking to combine incentives for providers to reduce spending with incentives to improve quality of care. Blue Cross Blue Shield of Massachusetts' Alternative Quality Contract, established in 2009, is an early example of a payment approach that relies on global budgets, shared risk, and pay-for-performance bonuses. In a recent study, Commonwealth Fund–supported researchers examined how the contract has affected quality of care and spending for children, including those with special health care needs.