Stop Paying for What Doesn’t Work: A Smarter Model for Digital Health ROI

The Streaming Paradox

Think about your streaming subscriptions for a moment. You’re paying for dozens, sometimes hundreds, of shows and movies, but if you’re being honest, you probably only watch a handful. The rest sit there, month after month, untouched, but you’re still footing the bill. You’re not paying for what you use or enjoy; you’re paying for access.

That’s exactly what’s happening in digital health today. Many employers are locked into per-employee-per-month (PEPM) pricing structures that mirror those bloated subscription models. You’re paying for the potential availability of care, not the care that actually gets delivered or the outcomes that result from it. Whether your employees engage with the program or ignore it entirely, you still write the same check each month.

What’s Wrong with PEPM?

The PEPM model became popular in digital health because it was simple and predictable. When digital health solutions first hit the market, this structure made sense because it allowed employers to offer wide access to emerging tools without having to micromanage individual utilization. But that early-stage model has long since outlived its usefulness. In today’s world of rising healthcare costs and growing demand for accountability, employers need to be smarter with their spending. They need to know that every dollar invested is producing actual value, not just theoretical access.

The real problem with PEPM pricing is that it completely misaligns incentives. Vendors get paid no matter what. There’s no built-in pressure for them to drive engagement or deliver better outcomes. If employees don’t sign up, don’t participate, or don’t complete programs, the vendor’s revenue stays exactly the same. Employers, meanwhile, are left covering costs for services that may be sitting idle, like all those unwatched channels in your streaming bundle. This dynamic leads to wasted budgets, overcrowded vendor rosters, and very little motivation for digital health partners to innovate or improve their performance.

Why Outcome-Based Pricing Works

What’s needed is a model that flips that equation. Outcome-based pricing does just that. Instead of paying for access, employers pay for results. Payments are tied directly to measurable success, whether that’s employees actually engaging with the program, demonstrating sustained behavior change, improving biometric markers, or hitting pre-defined health milestones. When vendors only get paid if they deliver, the incentive to perform is finally aligned on both sides.

This shift isn’t just about holding vendors accountable, it also protects employers financially. By tying payments to actual outcomes, employers avoid paying for programs that aren’t working for their population. And with more sophisticated claims-based modeling and population health assessments, they can even estimate costs more predictably, using real data to forecast likely outcomes before ever signing a contract.

At Solera, this is exactly how we’ve built our shared-risk model. We don’t believe employers should have to gamble on engagement rates or wonder whether their investment will translate into real-world results. Our contracts tie pricing directly to participant engagement and health outcomes. If we don’t help your employees improve, we don’t get paid. It’s that simple.

The Employer Advantage

This model also brings greater clarity to evaluating vendors. Instead of comparing flat fees or promotional pricing, employers can assess partners based on how well they define success, how transparently they report on outcomes, and how flexibly they can adjust based on real-time data. Metrics like Net Promoter Score, engagement milestones, and clinical improvements all become part of the conversation, not as afterthoughts, but as core components of the contract itself.

And for employers, this means greater control, clearer reporting, and ultimately, a higher return on investment. Every dollar spent goes toward programs that are demonstrably effective, rather than disappearing into a pool of unused services. Like finally cutting out all the streaming channels you never watch, outcome-based pricing ensures you’re only paying for the content you actually consume, and that’s delivering real value.

What to Look for in a Performance-Based Partner

Of course, not all outcome-based models are created equal. Employers should look for partners who offer transparency, flexibility, and real-time insight into results. At Solera, that’s core to how we operate. Our contracts are built around clear success metrics, real-time reporting, personalized journeys across multiple conditions, and outcome-linked pricing that ensures both sides are invested in making the program work.

Align Incentives, Maximize Value

Outcome-based pricing is more than just a different billing model. It’s a smarter, more responsible way to invest in digital health. In an industry where accountability has often been an afterthought, it brings alignment, transparency, and real partnership between employers and vendors. When both sides are invested in achieving meaningful outcomes, everyone wins.

Take the Next Step

At Solera, we believe employers deserve more than just access. They deserve results. That’s what our shared-risk contracts are designed to deliver. If you're ready to stop paying for what doesn’t work and start investing in what does, we’d love to show you how this model can work for your organization.

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