One of two value-based payment programs created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). There are four categories that were built from existing quality-reporting programs: quality (based on the Physician Quality Reporting System), resource use (based on the Value-based Payment Modifier), advancing care information (based on meaningful use), and clinical practice improvement activities (new category). The four categories establish a composite performance score (0-100) that will be compared against a threshold and then used to determine physician payment adjustments. (See Medicare and Delivery System Reform chapters.)