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Public accountability in health care is a strong and growing force shaping the practice of medicine today. Physicians and other providers should know who is monitoring their performance and the delivery of care, how their performance is measured and reported, and how initiatives intended to improve quality impact their practices. This module describes the key players in health care accreditation and assessment, current and emerging programs in performance measurement, and the role of report cards and pay-for-performance in creating incentives for quality improvement. The goal of this module is to present practitioners with information, strategies and tools to manage and provide high quality and cost-effective care for patients. It is one of several modules addressing the competencies of Systems-based Practice and Practice-based Learning and Improvement, presented in the Tufts Health Care Institute Online Learning Campus to help train medical residents and practitioners.