We hosted our second PHTI Summit in New York City on June 5th, bringing together a diverse group of clinical and payer experts, patient advocates, health economists, and investors to discuss the future of health technology adoption, artificial intelligence (AI) integration, and performance-based contracting. Our discussions centered on four themes that highlight how digital health purchasers are becoming more discerning and demanding, seeking clear evidence of clinical and financial outcomes to support their purchasing decisions.

Employers Are Leaning into Their Purchasing Power 

A small but growing group of employers are becoming increasingly sophisticated buyers, moving beyond flashy features to demand measurable impact to meet the needs of their employee populations. Large employers are setting new standards by telling vendors, "we won't pay unless you show us the impact on our employees with data we can trust." They're deliberately choosing quality over quantity, investing in solutions that provide demonstrable value rather than broad digital health portfolios. 

This shift is driven by digital health companies' improved ability to deliver measurable outcomes, creating market incentives that reward genuine value over superficial engagement metrics. Employers are now demanding that vendors share granular, user-level data to track performance, fundamentally changing the vendor-purchaser relationship. 

However, many employers lack the scale and infrastructure to directly contract for digital health solutions. These organizations rely on brokers and health plans to vet vendors, increasingly asking these partners for detailed criteria on how they evaluate and recommend digital health technologies. With access to unbiased, evidence-based evaluations, employers are better equipped to wield their substantial purchasing power as agents of accountability for the digital health sector. This demand for evidence is reshaping how success is measured across the industry. 

Moving Beyond Engagement: The Search for Meaningful Metrics 

After years of deploying digital health tools, purchasers have reached a clear conclusion: engagement alone does not guarantee impact. We've observed that in some cases, like virtual mental health tools, strong engagement aligns closely with positive clinical outcomes. In others, such as digital diabetes or hypertension management, high engagement may deliver little to no measurable clinical benefit. 

In turn, purchasers are no longer accepting engagement as a proxy for success. To justify reimbursement, they now examine the entire engagement funnel, demanding evidence that engagement leads to improved health outcomes. They want to understand whether someone initiated care, followed through, completed a program, and achieved meaningful results. 

This shift challenges entrepreneurs and investors to provide evidence of impact, not just usage statistics. It's driving collaboration between purchasers and digital health companies to refine evaluation standards and move beyond vanity metrics to rigorous, outcomes-driven definitions of success. 

The next frontier involves reaching people who don't typically use these tools but would likely benefit from them. Understanding how to meaningfully engage these populations will shape the industry's evolution. 

Outcomes Over Optics: The Rise of Performance-Based Contracting 

In our recent State of Digital Health Purchasing Survey, eight out of ten purchasers stated they are using performance or outcomes-based contracts for at least some of their digital health solutions. This represents a significant shift from traditional fixed per-member-per-month agreements, where it can be difficult to discern the value of solutions targeted to a specific subset of members. 

Vendors are increasingly confident they can deliver outcomes that can be measured, making performance-based contracts feasible. This confidence, combined with purchaser demand, has ushered in more data-driven, outcomes-focused contracting that prioritizes meaningful results over the broad deployment of digital health solutions. 

However, challenges remain in coordinating care benefits, educating employees on available offerings, and determining whether digital tools should complement or replace traditional care. Additionally, each contract remains bespoke to individual vendors and purchasers, creating administrative complexity. 

To address these challenges, we're leading an initiative with our Purchaser Advisory Council to accelerate these types of innovative pricing models. We're developing best practices and supporting the creation of sample contracts and standard definitions that will be published in early 2026, making it easier for both sides to adopt and negotiate performance-based agreements. 

AI's Promise and Peril 

Healthcare is experiencing an AI revolution unlike anything the industry has seen before. Ambient scribes are poised to become one of the fastest technology rollouts in healthcare history—in an industry notorious for glacial adoption cycles, no recent technology has been embraced more enthusiastically by clinicians or scaled so rapidly without a regulatory mandate. 

Health systems are racing to implement AI tools that promise to address their most pressing challenges: clinician burnout, administrative burden, and workforce productivity. AI is enabling new approaches to prior authorizations and coding, while health technology companies develop AI-powered tools to improve diagnosis and treatment. 

However, there's an urgent need for alignment on AI's purpose, value, and outcome measurement. Our findings from interviews with health system leaders on how they are thinking about and implementing AI reveal a nuanced reality: current evidence on productivity and financial performance is limited, with potential savings likely to emerge only as technology and implementation mature. 

Rapid AI adoption is already driving up costs, yet long-term economic implications remain unclear. Moreover, a growing tension has emerged in AI solutions that promise to both reduce burnout and increase revenue. Healthcare leaders need clarity about their goals, expected impact, and effects on clinical productivity, system efficiency, and finances. 

As AI tools become ubiquitous, we'll work with health systems leaders to help them answer critical questions: What are the primary goals of AI investments? How will progress be measured and outcomes tracked? How will improvements in provider burnout and patient experience be balanced against cost-effectiveness and greater productivity? 

Looking Forward 

The health technology sector's continued growth requires helping the market navigate competing dynamics, surface economic consequences, and orient decision-makers to the choices ahead. As an independent evaluator of digital health technology, we're committed to continuing our work with industry partners to raise the bar for evidence and impact—ensuring that digital health tools deliver on their promise to improve health outcomes while lowering costs. This shift from "let's try everything" to "let's invest in what works" represents digital health's maturation from promising technology to proven healthcare infrastructure.