What You Should Know
- The Peterson Health Technology Institute (PHTI) released its 2026 State of Digital Health Purchasing survey report surveying 321 digital health purchasing decision-makers across U.S. health plans (n=106), employers (n=115), and health systems (n=100) in partnership with KRC Research.
- The findings demonstrate a structural transition toward risk-bearing procurement, with a majority of commercial purchasers—including 68% of employers and 55% of commercial health plans (alongside 46% of health systems)—now utilizing performance-based or risk-based contracts.
- Financial stakes in digital health procurement are substantive: 85% of performance-based contracts tie at least 25% of total fees to measurable targets, while 31% put more than half of total contract value at risk (including 43% of health plans and 45% of health systems placing >50% of fees at risk).
The Shift to At-Risk and Performance-Based Contracting
Purchasers are actively moving away from paying purely for platform availability, using contracts as enforcement mechanisms:
- Broad Adoption of Risk: A majority of healthcare purchasers—57% overall, including 68% of employers, 55% of health plans, and 46% of health systems—are currently using performance- or risk-based contracts for digital health solutions.
- Significant Fees at Stake: Among organizations with performance-based agreements, 85% put at least a quarter of their contract value at risk. Specifically, 54% put 26%–50% at risk, 28% put 51%–75% at risk, and 3% tied 76%–100% of fees to performance benchmarks.
- Employers Cluster in Moderate Risk: While health plans and health systems are more willing to place >50% of contract value at risk (43% and 45%, respectively), employers heavily cluster in the 26%–50% at-risk tier (78%).
- Alignment with Federal Policy: This commercial trend parallels CMS’s rollout of the ACCESS model, which establishes outcomes-aligned payment structures for digital chronic care management.
The Verification Gap: Vendor Data vs. Payer Claims
While risk-based terms are widely signed, verifying whether performance thresholds were actually met has become a contentious administrative friction point:
- Data Integration Hurdles: 45% of purchasers cite difficulty integrating vendor data with their own internal medical claims or electronic utilization records as a top barrier.
- Methodological Opacity: 42% report that vendors rely on proprietary, non-transparent measurement methodologies, making objective reconciliation difficult.
- Cohort Cherry-Picking: 40% note that vendors report outcomes based on favorable, highly engaged subpopulations rather than the full attributed, eligible member population.
- Verification Deficits: 38% say they cannot independently verify the clinical or financial outcomes that vendors claim to achieve.
- Where Vendors Fail Most: When contracts tie fees to specific metrics, financial cost savings is where vendors most frequently miss their contractual targets (27% overall failure rate, including 31% for health plans and 28% for employers), followed by clinical outcomes (21%) and active member engagement (20%).
The Member Engagement Bottleneck
Purchasers are redefining engagement away from superficial signups toward active clinical utilization:
- Low Population Penetration: 47% of purchasers report that fewer than 25% of eligible members ever enroll in their contracted digital health programs, and another 39% see enrollment stall between 26% and 50%.
- Leading Driver of Vendor Churn: While overall solution cost remains the primary churn factor, lack of meaningful engagement has surged into the top three switching drivers across every segment (cited as a top switching factor by 40% of employers, 42% of health plans, and 37% of health systems).
- Evolving Contract Definitions: Purchasers increasingly refuse to define engagement by registration alone (only 51% of plans and 50% of health systems accept enrollment). Instead, contracts require active platform usage (85% of plans, 74% of employers) and completion of specific clinical milestones (76% of plans, 71% of health systems).
- Outreach Guardrails: Purchasers are restricting vendor outreach tactics, with 55% requiring explicit member opt-in consent before contact and 53% placing limits on permissible outreach channels to prevent member notification fatigue.
Budgetary Discipline and Portfolio Consolidation
Following years of expansion, digital health purchasing is stabilizing around fewer, more accountable vendors:
- Maintenance Over Growth: Over the next 12 months, 56% of purchasers plan to maintain digital health spending at current levels, while 38% plan to increase it and 2% plan to decrease it. This marks a major pivot from 2024, when 50% planned to expand budgets.
- Portfolio Trimming: Point-solution sprawl is contracting. Only 9% of purchasers now offer 11 or more discrete digital health solutions, down from 23% in 2025. Today, 76% offer 3 or more solutions, and 35% offer 6 or more.
- Share of Total Benefits: Digital health remains a small, highly scrutinized fraction of the broader healthcare ledger: 55% of organizations devote between 1% and 5% of their total health benefits budget to digital health, while 28% spend less than 1%.
- Clinical Priorities: Diabetes (60%), primary care / chronic care management (60%), and mental health (58%) remain the most heavily contracted clinical areas. Looking ahead, cardiovascular care (86%), mental health (83%), and primary care (82%) lead continued focus areas, while preventive care (41%) and cardiovascular health (37%) are the top areas purchasers plan to newly explore.
AI Deployment: Administrative Front Office vs. High-Stakes Clinical Care
Health plans and health systems are deploying AI across enterprise workflows, but adoption remains heavily concentrated in administrative, lower-risk tasks:
- Health System Deployments:
- Clinical documentation & ambient scribing: 71% have active deployments (41% running enterprise-wide, 30% in department-specific rollouts).
- Patient engagement & navigation: 69% have deployed (28% enterprise-wide, 41% limited).
- Administrative/operational automation: 67% have deployed (23% enterprise-wide, 44% limited).
- RCM & billing operations: 62% have deployed (20% enterprise-wide, 42% limited).
- Prior authorization automation: 57% have deployed (22% enterprise-wide, 35% limited).
- Clinical decision support (CDS): Significantly lags, with only 18% operating at enterprise scale (44% limited deployments, 22% in early pilots, and 12% not using).
- Health Plan Deployments:
- Clinical documentation review: 67% active (26% enterprise-wide, 41% limited).
- Claims operations automation: 65% active (30% enterprise-wide, 35% limited).
- Coverage determinations: 60% active (28% enterprise-wide, 32% limited).
- Member engagement & navigation: 58% active (29% enterprise-wide, 29% limited).
- Utilization management: 58% active (25% enterprise-wide, 33% limited).
- Care management: 57% active (25% enterprise-wide, 32% limited).
“Across both Medicare and the commercial market, payment for technology-driven chronic care management should be directly tied to clinical outcomes,” said Caroline Pearson, executive director of PHTI. “While the industry is broadly aligned on this approach, employers and health plans still struggle to negotiate and adjudicate these contracts, which often depend on vendors to report clinical and financial data. Easing these administrative challenges is essential to driving broader adoption of performance-based contracts. Over time, these contracts can actually generate more data about how vendors perform and help build confidence in digital health solutions.”
