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Performance-Based Contracting in digital health has moved from a limited purchasing concept to a common payment strategy among many employers and health plans, according to survey findings released by the Peterson Health Technology Institute in September 2026. The survey does not prove that every digital health tool improves health outcomes or lowers costs. It does show that purchasers are trying to connect vendor payment to measurable results, a shift with direct implications for affordability, access, and accountability.
For underserved communities, the stakes are practical. A digital health contract can look efficient on paper while still missing people who face language barriers, low broadband access, limited time away from work, disability-related barriers, or distrust of data collection. Payment design alone cannot solve those problems. It can, however, create stronger incentives for purchasers and vendors to define who is eligible, who enrolls, what outcomes are measured, and whether reported gains can be verified.
Performance-Based Contracting Survey Signals
Performance-Based Contracting Adoption
PHTI reported on September 29, 2026, that 68% of U.S. employers and 55% of health plans said they were using performance-based contracts for digital health tools at that time. Among contracts using these models, 85% tied at least 25% of fees to performance metrics, while 31% placed more than half of vendor-related payments at risk, according to the PHTI survey.
Those figures suggest that purchasers were not only testing symbolic incentive payments. A meaningful share of vendor revenue was tied to defined measures. Still, the survey findings should be read carefully. A contract can tie dollars to performance without answering whether the right patients were reached, whether outcomes were measured consistently, or whether cost changes reflected the tool rather than other shifts in care use.
Budgets And Risk Exposure
The same September 2026 findings indicated that digital health budgets were not broadly contracting despite wider healthcare cost pressure. From that September 2026 point, 56% of purchasers planned to maintain digital health spending over the next 12 months, and 38% planned to increase it. For companies selling digital health tools, stable or rising budgets may create room to accept more payment risk. For employers and plans, the key question is whether budget stability is paired with stronger evidence requirements.
For policy analysts, Performance-Based Contracting is best viewed as a purchasing method, not proof of clinical value. The method can push vendors to document results, but the value of any contract depends on the quality of the metrics, the reliability of data exchange, and the fairness of the eligible population definition. If the contract rewards only easy-to-reach users, it may understate access gaps and overstate real-world performance.
Evidence Metrics And Data Limits
Clinical Outcomes In 2024 Purchasing
PHTI’s 2024 purchasing survey, based on responses collected in mid-2024, found that clinical outcomes were the most common performance metric across health plans and health systems: 95% of health plans and 88% of health systems used clinical outcomes as a metric. Employers were less consistent, with many also using engagement or adoption measures, according to the 2024 purchasing survey.
Clinical outcomes are often more meaningful than app downloads or logins, but they can be harder to measure fairly. A digital hypertension tool, a virtual musculoskeletal solution, and a digital mental health product may require different measures, timeframes, and data sources. PHTI’s materials updated on September 21, 2026 described condition-specific toolkits for areas such as digital diabetes management, virtual depression and anxiety solutions, digital hypertension management, and virtual musculoskeletal solutions. That condition-specific approach is relevant because a single generic metric may not capture whether a tool supports the population it claims to serve.
Verification And Integration Problems
Data problems remain a major constraint. In the September 2026 survey, 45% of purchasers said vendor-provided data was difficult to integrate with their own claims or utilization data, and 38% said they could not independently verify the clinical and financial outcomes reported by vendors. These concerns matter because payment risk can be only as credible as the measurement system behind it.
If vendors report their own outcomes without independent review, purchasers may face a conflict between wanting innovation and needing accountability. If claims data and vendor data cannot be matched, it becomes harder to know whether a digital tool reduced avoidable care, shifted care to a different setting, or simply documented activity among users who were already engaged. For broader coverage and insights within the same network, PetraClass offers related policy and learning resources.
Equity And Affordability Implications
Engagement Below Eligibility
The September 2026 survey also found that 47% of purchasers reported fewer than 25% of eligible members enrolled in the digital health solutions offered. That figure is especially relevant for equity analysis. If only a small share of eligible people enroll, a positive result among users may not reflect whether the tool worked for the broader covered population.
Low enrollment may stem from many causes that the survey did not break down in the research notes provided here. Possible factors can include awareness, trust, device access, digital literacy, language access, schedule constraints, benefit design, or referral patterns. Because the provided research does not quantify those causes, they should be treated as areas for review rather than assumed explanations. For broader educational reading in the connected domain, PetraClass offers insights on related policy and learning perspectives.
Why Contract Design Matters
Performance-Based Contracting can either expose access problems or hide them. A contract that measures only enrolled users may reward a vendor for serving people who are easiest to reach. A stronger design can ask whether eligible members were contacted, whether enrollment was equitable across groups, whether support was accessible, and whether the tool worked for people with higher needs.
Affordability analysis should also separate purchaser savings from patient experience. A health plan or employer may seek lower utilization or better condition management, but members may care about out-of-pocket costs, time spent using the tool, data sharing, and whether the digital service connects back to their clinician. A tool that adds another portal without reducing friction may not feel affordable to the person using it, even if the contract shifts financial risk to the vendor.
Contract Terms Purchasers Should Scrutinize
The most useful contract terms are usually specific, measurable, and fair to both the purchaser and the population served. The research notes point to recurring themes: outcome measures, eligible populations, engagement thresholds, and data-sharing protocols. Each of these terms has equity implications.
| Contract Area | Question For Purchasers | Equity Concern |
|---|---|---|
| Eligible Population | Who is counted as eligible for the tool? | Narrow eligibility may exclude people with higher needs or less stable access. |
| Engagement Thresholds | What level of use is required before payment is earned? | High thresholds may penalize people with limited time, disability-related barriers, or limited device access. |
| Outcome Measures | Are clinical and financial outcomes defined before launch? | Unclear measures make it harder to detect unequal results across groups. |
| Data Sharing | Can purchaser data and vendor data be matched and reviewed? | Poor integration limits independent verification and weakens accountability. |
Purchasers should also be cautious about assuming that more risk automatically means better value. If vendors accept high payment risk but the measures are weak, the contract may still fail to answer whether patients received useful support. If measures are too narrow, vendors may avoid users who need more assistance. A fair contract should not reward avoidance of people whose care is harder to coordinate.
Performance-Based Contracting Questions For Care Teams
Performance-Based Contracting is mainly a payment and purchasing strategy, but its effects can reach patients and clinicians. A person offered a digital health tool may reasonably want to know how the service fits into their care, who reviews the information, and whether use of the tool affects costs or coverage. Those are practical questions, not signs of resistance to technology.
- Ask whether the digital tool is meant to supplement usual care or replace any part of it.
- Ask who can see data entered into the tool and how that data is used in care decisions.
- Ask whether there are costs, device requirements, language options, or accessibility features to consider.
- Ask how concerns, side effects, worsening symptoms, or urgent issues should be handled outside the app.
A patient should not start, stop, or change a treatment plan because of a digital tool without discussing the decision with a qualified clinician. If an employer or health plan offers a digital health program, the safest next step is to ask a clinician or care team whether the tool fits the person’s health needs, medications, age, pregnancy status when relevant, disability needs, and existing care plan.
