The days of paying digital health vendors just for showing up are fading fast. A new survey from the Peterson Health Technology Institute (PHTI), drawing on insights from 321 digital health purchasing professionals, finds that the majority of employers and health plans have moved to performance-based contracting — meaning vendors only get paid (or get paid more) when they actually deliver results.

The trend is getting a boost from CMS's ACCESS model, launched in December, which establishes outcome-aligned payments for digital health tools and chronic care management. Still, the road isn't entirely smooth — 45% of respondents struggle to integrate vendor data with their own claims systems, and 38% can't independently verify the outcomes vendors report.

By the Numbers:

• 68% of employers and 55% of health plans use performance-based contracts
• 85% of contracts tie at least 25% of fees to performance; 31% tie more than half
• 64% of purchasers increased digital health spending this year, down from 75% in 2024
• 56% plan to maintain current spending over the next 12 months

Why it matters: As digital health tools multiply, payers and employers are demanding proof that they work — not just promises. Performance-based contracts could ultimately generate richer data on vendor effectiveness, building long-term confidence in digital health solutions.