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Summary: Health care systems across the world have increasingly embraced a value-based health care (VBHC) agenda. They do so for different reasons, using different foundations, and variations on the tools and tactics to effect their strategic goals. The role of governments, providers, and private payers varies, as do funding and payment schemes. In their review of 4 systems — Massachusetts (USA), the Netherlands, Norway, and England (UK) — the authors find that elements of the theoretical framework function better in some health care systems than others. Understanding of these strengths and weaknesses can yield insights for policymakers and providers as they strive for a more patient-focused, value-based care delivery environment. Government involvement can facilitate change by setting the right conditions (e.g., for regional system integration). Continuous IT improvements to ensure the availability of outcome data across the full care cycle and instituting a value-based culture among providers are keys to driving VBHC implementation.