This study was supported through a contract (HHSP23320095642WC) from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services. Special thanks are due to Hakan Aykan and Allison Cuellar at ASPE for their early support of this effort, to Randall Brown and Kate Stewart at Mathematica Policy Research for their many helpful comments, and to staff at the National Committee for Quality Assurance (NCQA) for the substantial assistance they provided in the participant recruitment process. NCQA did not otherwise participate in discussions with respondents, review or approve these analyses, or provide any incentives to participants. We are most grateful to the individuals who participated in the study for the time they spent answering our many questions with great care. The observations contained in this document represent the views of the authors and do not necessarily reflect the opinions or perspectives of any state or federal agency.