With a few exceptions, value-based healthcare in the form dictated by the Institute of Clinical Health Outcome Measures (ICHOM), is limited to the rich world. That is not the vision of ICHOM’s founders, however. They want global measurement and benchmarking– essentially, the wider the search for best practice, the more variation and the more sites of competitive selection. Pharmaccess and the Novartis Foundation, who both spoke at the ICHOM conference, are slowly pushing the envelope.