Canadians pride themselves in their healthcare system. Yet, multiple problems are the focus of ongoing debates. The adoption of effective clinical and organizational interventions to improve health outcomes has not kept pace with the science. Solutions lie in health system redesign to improve quality and efficiency, focusing on the goal of improving population health. This commentary addresses the original conception behind medicare – an unfinished task; the implementation of a quality agenda; and the use of patient-reported outcome measures (PROMs) to inform the development and evaluation of tailored interventions. Finally, it offers considerations for moving the health system forward toward the ultimate goal of keeping people well.