Healthcare transformation is in the news again. Once again the dialogue will focus on the most frustrating constant of providing care: costs always increase. But there is another constant in healthcare that rarely makes the mainstream discussion: over half the costs are due to the lack of engagement of the chronically ill with their therapy. The CDC says that 86 percent of all U.S. healthcare costs are due to chronic disease and over 50 percent of those costs are attributable to patient behavior. Responsibility for the lack of attention usually focuses care givers, i.e. the need for Accountable Care Organizations, and occasionally politicians who believe this is a “third rail” topic.