“Show me the incentives, and I will show you the outcome.”. The notion of “value-based healthcare” has been a strategic priority in the U.S. for over a decade now. Value-based care promised a future in which our healthcare system (and its consumers) would systematically pay for value, rather than volume. In principle, aligning incentives to value would curb healthcare spending while simultaneously improving patient outcomes. To their great credit, the Centers for Medicare and Medicaid Services (CMS) explored numerous value-based care models and alternative payment structures over the last 10+ years, ranging from performance-based bonus payments to shared savings programs administered through accountable care organizations (ACOs). Why, then, do we still face rising healthcare costs, continued threat of Medicare Trust Fund insolvency, a widening health equity gap, and growing primary care provider burnout? In our view, the short answer: we lack technology and infrastructure that enables individual providers to be incentivized by value, and take on risk.