You have heard the mantra about searching for value in healthcare. There have been dozens, hundreds, or thousands of federal policies depending on how you parse the Federal Register and entire organizations such as AHRQ, MedPAC and the CMS Center for Clinical Standards and Quality dedicated to this one goal. Why has finding value been so elusive? To a large extent, our struggle to find value dates back to 1942 when, after the Roosevelt administration froze wage hikes to forestall inflation during World War II, employers turned to healthcare benefits as a major recruiting tool. The subsequent growth of employer-sponsored insurance limited the impact individual consumers could have on the market. Today, we are seeing advances in computing transform the calculus of consumer choice in almost every industry telecom, retail, travel, entertainment, banking, publishing but healthcare still lags. Much of the value measurement space represented by tools such as quality measures and prior authorization have been attempts to provide proxies for value to consumers / patients to fill the void in choosing what to pay for in healthcare.