This book provides a balanced assessment of pay for performance (P4P), addressing both its promise and its shortcomings. P4P programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness. On a positive note, this movement has developed and tested many new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care. The current interest in P4P echoes earlier enthusiasms in health policy—such as those for capitation and managed care in the 1990s—that failed to live up to their early promise. The fate of P4P is not yet certain, but we can learn a number of lessons from experiences with P4P to date, and ways to improve the designs of P4P programs are becoming apparent. We anticipate that a “second generation” of P4P programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs.

The legacy of Hillcrest University starts out just like any other. A girl, some boys, a bit of mystery...a noose. Actually, it all begins with the noose. A noose, a note, and a corpse. And a pretty one at that... I thought coming to HU would help me move on from my past, help me get a good start on my future. A school for rich boys? Please. I've dealt with worse than them before. If they want to use me for whatever games they're playing, they'll have to try a lot harder than they're used to. They think I'll willingly walk into their feud, choose sides. Declan is the tortured soul, the cute, depressed roommate who I'm supposed to watch over. Sawyer is the king of the school; everyone follows his command--and his money. Travis is...my kind of trouble: sexy, tattooed, a bit mysterious. Sawyer blames Declan for his sister's death, but me? I know sometimes the ones pointing their fingers are the worst of all. Did someone kill his sister? I know better than to assume their innocence. In a place like Hillcrest, you can't trust anyone. Declan, Sawyer, and Travis? They all wear masks. The better question is: if someone killed her, are they going to come after me next? These rich, entitled brats have no idea who they're messing with. **Loser is a darker romance, meaning there are topics that might offend you. Self-harm, suicide, stalking, and more to come in future books. Be warned.**