Given the context of continually increasing health care expenditures, value-driven health care is a concept that is gaining attention. Optimizing quality and efficiency provides greatest value, and aligning financial incentives through, for example, pay-for-performance programs, is a strategy growing in popularity. Such programs lack evidence of effectiveness for improving health outcomes and may have the potential limitations of opportunity costs and further disenfranchisement of vulnerable populations. However our current health care system is unsustainable, and fundamental reform is indicated. Financial incentives may prove to be an effective strategy for improving quality and efficiency and deserve exploration, but pay-for-performance programs warrant further evaluation, with attention directed to identify and respond to any adverse unintended effects of these programs.