A Breakthrough in Real-World Evidence May Redefine the Value Proposition

Leveraging AI to bridge the clinical-to-real-world evidence gap

As the cost of specialized therapies continues to rise, US payers are entering 2026 facing unprecedented cost pressures and a mandate to modernize benefit design. In response, health plans are accelerating the shift toward Value-Based Contracting (VBC). Recent industry reporting indicates that 30% of organizations are deriving at least a quarter of their total revenue from VBC contracts.¹

However, these agreements have historically been stifled by an evidence gap: the manual, fragmented, and delayed process of tracking real-world patient outcomes. In this landscape, the strategic opportunity is presenting real-time value.

“We’re thinking about not just leveraging new technology for VBC conversations—thoughthat’s where we’ll start. This is really about changing the nature of the entire value proposition conversation with payers,” according to Diane Petrone, Senior Vice President, Strategic Services.

As with many facets of the changing nature of the brand value proposition, there are AI solutions that can serve as the connective tissue between real-world clinical performance and reimbursement. The tools for a Dynamic Value Framework that Petrone envisions would leverage agentic AI to align manufacturer real-world evidence (RWE) with the automated adjudication systems payers are now deploying. By prioritizing a more streamlined orchestration of RWE, manufacturers can provide payers with actionable data to support broader coverage. This transforms the value story from a static, annual presentation into a living, data-driven proof-of-value platform.

Largely this is a matter of brands catching up to where customers are heading. Payers are already turning the keys over to AI to meet provider-side data optimization in real time. Currently, 70% of healthcare leaders are optimistic about AI’s role in enabling predictive analytics to scale VBC strategies,1 and 97% of health plan executives expect agentic AI to add significant value to clinical validation functions.2 Brands must move toward an agile, data-driven strategy to manage the shifting standards of US payers. By ensuring a product’s value story is AI-ready—built to feed into a payer’s own analytic engines—brands can help ensure their clinical success is recognized and rewarded in real-time.

A shift in focus, and tempo

To implement a new dynamic value proposition, organizations must prioritize data orchestration over data accumulation. This may look like agentic systems capable of processing that data into actionable insights that align with payer-side analytics—and then tailor those insights to different payers’ criteria, population, and coverage situation.

“None of which is to say we don’t need a human in the loop,” says Petrone. “In fact it’s all the more crucial for a collaborative team of Medical, Market Access, HEOR, and Data Analytics to be at the table with the rest of the brand as early as possible—from well before launch—to set the strategies for how to deploy this new value framework.”

In 2026, applications of agentic AI are already being used to manage the collection and analysis of pharmaceutical data for contracting and regulatory activities. Joining early adopters in accelerated data analysis & promotion can shift the brand proposition to one of proactive, continuous value delivery. Account teams would no longer be selling based on a moment-in-time clinical trial; they’ll be engaged in a dynamic value conversation supported by a real-time digital chain of evidence. This may represent the new standard of trust in the 2026 healthcare market.

References

1. Tong N. Value-based care revenue expected to increase in 2025, survey respondents agree. Fierce Healthcare. https://www.fiercehealthcare.com/providers/value-based-carerevenue-expected-increase-2025-survey-respondents-agree. May 16, 2025. Accessed January 16, 2026. 2. Deloitte. 2026 US health care outlook. https://www.deloitte.com/us/en/insights/industry/health-care/life-sciences-and-healthcare-industry-outlooks/2026-us-health-care-executive-outlook.html. December 11, 2025. Accessed January 16, 2026.

Authored By:

DIANE PETRONE, SVP, Strategic Services

SAM RIVERA, SVP, Creative,