[10][11] In 2007, then-CEO Cleve Killingsworth set a six-month deadline for the company to come up with a new payment plan to offer health care providers.

[12] Killingsworth thought existing pay for performance initiatives were insufficient to prevent billions of dollars in wasteful health care spending that either harmed or did not help patients.

[12] Under the AQC model, groups of doctors and hospitals are paid set fees "to work as a team in caring for patients.

[14] When the company was introducing AQCs to providers, "state lawmakers started talking about payment reform", leading to unexpected interest.

[12] In 2011, the large provider group Partners HealthCare joined the AQC, accepting lower than expected payment levels, possibly preempting regulatory moves to control costs.