The published evidence regarding improvements in performance from the value-based purchasing experiments of the past decade is mixed (i.e., positive and null effects); where observed, improvements were typically modest. Many of the published studies evaluating the impact of pay-for-performance programs suffer from methodological weaknesses that make it hard to determine whether the value-based purchasing intervention had an effect above and beyond other changes that were simultaneously occurring to improve quality and restrain spending (Che et. al, 2016). In my organization, we accept Medicare and Medicaid patients. My clinic also has negotiated rates with good insurance providers in the region like Cigna and United. However, since the payment for dental services for in network or out of network is not that varied and difficult, we also have other insurance provider members coming to the clinic as well. But surely, for them, the costs are higher. We also support normal cash payments from people who do not have insurance and we strive to offer lower rates since the clinic's setting is in a location where the median income is on the lower side