Summary
- Health plans, employers, and health systems are increasingly tying payment for digital health solutions directly to clinical and financial results.
- A majority of purchasers, including 68% of employers and 55% of health plans, indicate they are currently using performance-based contracts.
- When those purchasers use performance-based contracts, they put substantial payments at risk—with 85% of contracts tying at least a quarter of fees to performance.
- Artificial intelligence is widely adopted among health plans and health systems, though many of these deployments are limited in scope.
Findings
Most employers and health plans now use performance-based contracts for digital health
Health plans, employers, and health systems are increasingly tying payment for digital health solutions directly to clinical and financial results.
- A majority of purchasers, including 68% of employers and 55% of health plans, indicate they are currently using performance-based contracts.
- When those purchasers use performance-based contracts, they put substantial payments at risk—with 85% of contracts tying at least a quarter of fees to performance and 31% of contracts having more than half of fees at risk.
- This shift to paying for performance aligns with the Centers for Medicare & Medicaid Services (CMS)’s new ACCESS model, which establishes outcomes-aligned payments for digital health solutions for chronic care management.
Weak member engagement is a leading reason purchasers switch digital health vendors
For digital health tools to improve outcomes, they need the ability to recruit, engage, and retain patients.
- Purchasers indicate that strong member engagement is a prerequisite for increasing their digital health spending (64%).
- 47% of purchasers say that fewer than a quarter of their eligible members enroll in these solutions.
- Respondents say that poor member engagement is the leading reason they switch vendors.
Most purchasers plan to hold digital health budgets steady
Despite widespread reporting of purchasers paring back benefits in the face of rising costs, those surveyed indicate they plan to maintain their budgets for digital health technologies at current levels.
- Over the next 12 months, a majority (56%) plan to maintain their current digital health spending, while 38% plan to increase it.
- Digital health portfolios are becoming more focused, with fewer purchasers offering 11 or more unique solutions.
Initial AI adoption by health plans and health systems has been focused on administrative tasks
Artificial intelligence is widely adopted among health plans and health systems, though many of these deployments are limited in scope.
- Among health systems, clinical documentation and ambient scribing lead, with 71% reporting some level of deployment, including 41% running enterprise-wide.
- Higher-stakes use cases lag well behind: just 18% of health systems report enterprise-scale deployment of AI for clinical decision support.
- For health plans, clinical documentation review is the top use case, with 67% reporting some level of deployment, followed closely by claims automation at 65%.
Methodology
PHTI surveyed 321 digital health decisionmakers who are responsible for purchasing decisions in health plans, employers, and health systems. The survey was fielded between July 1 and July 22, 2026.
