This book provides the first in-depth analysis of a major federal management reform under the most difficult conditions for measuring performance and accountability: when government functions are contracted out to third parties. The authors systematically examine the workings of the Government Performance and Results Act (GPRA) of 1993, with consideration of the later Program Assessment Rating Tool (PART) of 2002 in five agencies in U.S. Department of Health and Human Services. These programs represent much of the range of federal government organizational structures and a diverse array of third-party arrangements, including states, native American tribal leaderships, scientists, medical schools, and commercial and non-profit health intermediaries and carriers. The authors explore the development of performance measures in light of the mandates of each program, conflicting statutes, political considerations and obstacles, and conditions of intergovernmental relations (where applicable). Their findings illuminate two major questions in public management today: the uses and limitations of performance measurement as a policy and management tool in government and the management of third-party government.