Drawing from prior research, data collected from physician interviews, and discussions with stakeholders, we note opportunities for health insurers and other purchasers to promote a practice environment that supports more evidence-based recommendations. These opportunities include reforms to traditional fee-for-service modes of physician payment and selective contracting with physician organizations. Our analysis suggests that the feasibility and likely effectiveness of different strategies can vary considerably across practice settings, communities, and clinical problems. We conclude that the most promising strategies are those in which local payers and community organizations offer resources or preferential payments so physicians and practices can adapt their point-of-care setting to facilitate more evidence-based care.