Sponsors unanimously agreed that interaction with hospitals is critical to P4P program success. They stated it was important to engage and work collaboratively with hospitals “early and often” in all aspects of the program design and operation. Sponsors noted that this builds a sense of ownership and partnership among hospitals involved, which, in turn, helps increase acceptance of and support for the P4P program. Program sponsors also feel it is important to provide quality improvement guidance and support to hospitals as part of an ongoing feedback loop. Many sponsors viewed their role not only as the operational manager of the P4P program, but also as an important quality improvement resource for hospitals. They underscored that if performance improvement is truly a goal of the P4P program, mechanisms must be built in to provide assistance to hospitals that are trying to improve.