In this exercise, students read a brief medical history of fictional patient Mr. Jones, who has chronic low back pain (LBP). They are also given an overview of LBP and its treatment options in the United States. Their task is to develop a value-based payment system that defines outcome measures (patient success) over time and indicates how to compensate clinicians based on those outcome measures, then to create a short presentation to pitch their idea to the Centers for Medicare and Medicaid Services management team. This exercise is taught at Darden in the "Solutions and Innovations in Health Care" course and would also suitable in a module covering reimbursement in the health system.