Implementing outcomes measurement is challenging, and important issues remain. In particular, using outcomes measures to compare providers creates incentives to treat patients who are most likely to improve. Methods for risk adjustment in psychiatry are as yet inadequate, and we must ensure that no program penalizes our sickest patients or their treatment providers. Moreover, we must recognize that quality can never be reduced to a single domain. Still, there are many benefits to measuring outcomes, and even imperfect systems, if applied sensibly, have the potential to improve care. The recent experience with the Blue Cross Blue Shield outcomes measurement program is illustrative. Even though not every aspect of the program was exemplary, it did contain a number of necessary features for improving care. It used a standardized instrument with known psychometric properties and proven sensitivity to change (7). The vendor provided rapid scoring and feedback delivered to the point of care. Aggregate data were maintained and available for evaluation. These are key components of a successful outcomes measurement program.