The operating executives of Health and Benefits for Onex Partners, Megan Jackson Frye and Sam Camens, faced a challenge: Healthcare costs for employees of Onex's portfolio companies were continuing to rise above the consumer price index, reflecting broader trends across employer-sponsored health insurance in the U.S. Against this backdrop, Frye and Camens considered recommending that Onex's portfolio companies adopt value-based insurance design (VBID) principles to encourage employees to take high-value medications, for example by reducing copays for drugs managing diabetes or heart conditions. The case encourages students to put themselves in the shoes of Frye and Camens, who were grappling with evidence promoted by VBID's proponents on its potential to simultaneously improve employee health and curb employer costs. The case includes content on employer-provided health insurance in the U.S., as well as the consequences of cost-sharing on consumer behavior, health, and spending.