OBJECTIVES: Value-based contracts (VBCs) have gained significant attention in the healthcare sector as a promising approach to improve outcomes while managing costs.

METHODS: Insights were gathered from in-depth interviews (N=20) conducted with payers across different archetypes (public, private, national, regional) from Europe (Germany, Italy, The Netherlands, Sweden, and Spain), Latin America (Argentina, Brazil, Colombia, and Mexico), Asia-Pacific (APAC) (Australia, China, South Korea, and Taiwan), and the US. From the data collected, a matrix was constructed, associating various conditions with distinct types of value-based contracts.

RESULTS: The study examined six key conditions: treatment type (chronic vs. one-time), healthcare system organization (centralized vs. decentralized), contracting level (hospital vs. regional vs. national), treatment landscape (evolving vs. static treatment paradigm), clinical endpoint (objective vs. subjective), treatment uncertainty (clinical vs. economic), and patient population size (orphan vs. non-orphan). Seven value-based contract types were considered: discount/rebate, price-volume agreement, budget cap, patient cost cap, utilization cap, pay-for-performance, and coverage with evidence development.

Among the contract types, discount/rebate was found to be applicable to all situations, while pay-for-performance was suitable for the fewest. For treatments addressing chronic orphan conditions in a static clinical landscape within a centralized healthcare system, multiple contract types were viable, contingent on the identified uncertainty. This highlights the importance of tailoring value-based contracts based on specific contextual factors.

CONCLUSIONS: The findings offer valuable insights for policymakers and stakeholders in designing value-based contracts that align with the unique characteristics of different healthcare contexts and therapeutic areas.