For many of us change is a difficult process. In organizations like healthcare it seems to advance at a snail’s pace sometimes. There is a need for change in healthcare, most agree, though we would be hard pressed to agree upon the changes needed. One incentive for change is pay-for-performance programs now beginning in several areas. I would like to describe a couple that affect primary care physicians and then give a few suggestions as to how to adopt changes to take advantage of these program.