Competing interests: Karen Dorsey receives funding under contract with the Centers for Medicare and Medicaid Services to develop and maintain quality measures and from Humana, Inc. to advise on quality strategy. In the past three years, Harlan Krumholz received expenses and/or personal fees from UnitedHealth, IBM Watson Health, Element Science, Aetna, Facebook, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, Martin/Baughman Law Firm, F-Prime, and the National Center for Cardiovascular Diseases in Beijing. He is a co-founder of Refactor Health and HugoHealth, and had grants and/or contracts from the Centers for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, National Institutes of Health, American Heart Association, and Johnson and Johnson. Daisy Massey has no potential conflicts to report.