Moving toward greater value in healthcare in Canada requires more than novel tools and policy levers. First, we need clear objectives, namely, value as defined across stakeholders with primacy given to patients and the public. Next, an unwavering commitment by payers, providers and system managers to pursue those definitions of value. At the most basic level, we need to remember whom the healthcare system is working for. Although numerous pilot projects and promising examples exist, pursuing value in healthcare in Canada will likely require a reassessment of some fundamental aspects of our healthcare systems. A pragmatic approach of learning from the successes and failures of current efforts combined with a major rethinking of the foundational and operating principles of our current systems may be required to get there from here.