OBJECTIVES: To explore how value-based contracts (VBC) in healthcare are perceived and compare financial-based agreements (FBAs) and outcome-based agreements (OBAs) with regards to their practical implementation and feasibility, as well as challenges to the expansion of OBA and FBA adoption in different contexts.

METHODS: Twenty stakeholders comprising senior officials with long experience on VBC implementation and representing public and private payers from 14 countries covering North and South America, Europe, and Asia-Pacific were interviewed between February and May 2023. In-depth individual interviews were designed to investigate the perceptions of the use of VBCs in healthcare using a semi-structured interview guide. The classical taxonomies of FBA and OBA were used to compare the implementation opportunities and challenges.

RESULTS: Interviewees highlighted multiple challenges that prevent VBC implementation in their respective countries. Although OBA implementation is perceived as more challenging than FBA, there are opportunities for both types of VBCs across countries. There was a common understanding that FBAs are associated with more opportunities (mainly achieving health expenses control through different means) than barriers (mainly administrative burden and complex financial flows). OBAs on the other hand, were associated with more barriers (including incentives alignment, insufficient outcomes data gathering capabilities, complex money-back schemes) than opportunities (mainly addressing clinical outcome uncertainty and generating real-world evidence). No clear pattern on preferences was identified between regions, but some countries were prone to widening the use of VBCs according to their past successes and failures.

CONCLUSIONS: VBCs in healthcare are still perceived as facing multiple challenges that prevent wider implementation, in particular in the case of OBAs.