Sweeping change to the structure and funding of the U.S. health care system has emerged as a dominant issue in the 2020 U.S. Presidential Democratic primary. Most of the candidates’ policy proposals involve expansion of publicly funded health care to close the coverage gap that results in millions of Americans going uninsured each year. As the debates over how best to restructure the U.S. health care system wind down, the conversation will likely shift back toward one promising approach to reducing health care costs and improving quality of care – Value Based Payment (VBP) programs.