ABSTRACT: In 21st century health care, the nature and terms of contracts between health care providers reflect an evolving patchwork of laws, regulations, and medical practice rules. On the flip side, since provider contracts govern the specifics of who will be paid for what services and under what conditions, provider contracts are primary drivers of the nature and terms of interactions between and among providers and between providers and patients. The dual status of provider contracts as both the cause and effect of laws, rules, and policy means that such contracts may be an important conduit through which laws, regulations, and policy impact care delivery. It also means that provider contracts, and those who assist in their drafting and implementation, may significantly influence the type and scale of effect that evolving laws, regulations, practice rules, and policy have on care delivery. Through the lens of the opioid crisis, this article will explore how provider contracts that include pay-for-performance (P4P) principles (contracts referred to as “incentive-based provider alignment agreements”) both reflect and influence health care culture and practices, and the evolving role they may play in shaping the impact of laws, regulations, practice rules, and local and national policies.