The challenges health systems often face in aligning physicians with organizational cost and quality goals related to the delivery of value-based care differ between employed and independent physicians. With employed physicians, the focus should be on right-sizing the service delivery network and employed medical group, building a sustainable compensation program, enhancing the revenue cycle, increasing use of midlevel providers, and implementing a common technology platform. With independent physicians, the focus should be on understanding available contracting models, participating in shared-savings arrangements, considering alternative payment distribution models, choosing the right metrics, and exploring shared branding options.