OBJECTIVES To identify and categorize publicly available cases of performance-based health outcomes agreements. METHODS We performed a systematic review of performance-based health outcomes agreements over the past 20 years (July 1998 – October 2008) using publicly available databases and input from colleagues and health care experts. We further developed a taxonomy of agreement types by inductively organizing the cases identified according the timing, execution, and health outcomes measured in the agreements. RESULTS Our search yielded in excess of 60 documents including peer reviewed articles, secondary publications, websites and in-person communications. From this set, we identified 28 agreements categorized as coverage with evidence development, eight that were categorized as conditional treatment continuation, and ten agreements categorized as performance-linked reimbursement. Because of current national reimbursement policies, devices appear to be the best candidates in the US, whereas pharmaceuticals appear to the best candidates for EU and other non US payers. CONCLUSIONS With a relatively small number of cases from which to draw conclusions, it is difficult to ascertain whether performance-based health outcomes agreements signal a fundamental change in reimbursement policies. Given the interest to date and the potential to meet the goals of interested stakeholders, these agreements have the potential to become more common in health care. However, significant challenges including high transaction costs and insufficient information systems may limit the long-term impact and viability of health outcomes based agreements. Future studies regarding the attitudes and perceptions of various stakeholders are needed, as well as evaluations of the results and experience with the agreements implemented thus far.