Value-Based Procurement (VBP) , an approach to healthcare purchasing that evaluates technologies and services not only on the basis of price but also on the overall value they generate for patients, healthcare professionals, and the healthcare system, has moved beyond the stage of theoretical debate. A community of organizations is now ready to put it into practice. However, the willingness of individual organizations is not enough: without governance capable of supporting change, a coherent regulatory framework, and long-term investment, VBP risks remaining confined to a handful of pilot projects instead of transforming how healthcare systems decide what to buy and why.
This is one of the main conclusions emerging from the contribution made by the MASAN Observatory team to the Value-Based Procurement Community of Practice promoted by MedTech Europe, which brings together hospitals, purchasing organizations, and market operators. Many public and private organizations say they are ready to invest in VBP. The readiness of individual organizations, however, does not yet translate into readiness across the system as a whole.
Value is inherently a dynamic concept, but if it is to guide procurement decisions, it must demonstrate its impact on organizations' financial sustainability and, ultimately, on budgets. This means clearly defining what should be measured, how it should be measured, and which data need to be collected to demonstrate that impact.
The UK's National Health Service (NHS) is moving in this direction, having recently published national guidelines on Value-Based Procurement. The document proposes an evaluation framework for medical technologies based on five dimensions of value: social value (social and environmental benefits), efficiency (improvements in the care pathway), patients and staff (the experience and safety of patients and healthcare professionals), supply chain resilience, and fitness for purpose. These dimensions are combined with the product's total lifecycle cost. The most innovative feature is the introduction of a maximum weighting of 40% for cost and a minimum weighting of 10% for social value. However, the UK guidelines focus exclusively on the bid evaluation phase and, indirectly, on the definition of technical specifications. It is understandable that attention should concentrate on this stage, which is crucial for supplier selection. The risk, however, is that excessive emphasis will be placed on the tender itself, while overlooking the equally important phases of procurement planning and outcome monitoring.
In contexts such as Italy, characterized by highly prescriptive regulations and a high level of litigation, a broader approach is needed. This is the rationale behind the model developed by SDA Bocconi through the MASAN Observatory, known as the Value-Based Procurement Process . The idea is to extend the concept of value across the entire procurement process: upstream, when deciding what to purchase and with which objectives, and downstream, when measuring the outcomes actually achieved.
Making this approach possible requires robust evidence. This includes Health Technology Assessment (HTA) evaluations, which analyze the clinical, economic, and organizational value of healthcare technologies, as well as data collected through small-scale pilot projects. These projects can be implemented by making use of contract extensions, temporary contract renewals, below-threshold procurement procedures, or dedicated innovation funding such as those available through Horizon Europe. These pilot projects serve another important purpose as well: they make it possible to design dedicated clinical pathways in which value is generated through the combination of the purchased technology, the organization of care delivery, and any additional services provided by the supplier. Without this integration, the technology's potential clinical and economic value may never translate into tangible results.
VBP: What, how, and why
But what does it actually mean to "purchase value"? When defining a procurement strategy, it is essential to understand both the characteristics of the technology being acquired and the type of value the organization aims to generate. For technologies that have already reached maturity, value lies primarily in expanding access to care, improving patient pathways, reducing waste, increasing safety, and enhancing the experience of both patients and healthcare professionals. In these cases, the most effective approach is to define functional requirements, include complementary services, and establish payment mechanisms linked to clearly identified value objectives, for example, by introducing progressive incentive schemes tied to the achievement of specific performance levels.
The situation is different for truly innovative technologies designed to address previously unmet clinical needs. Here, it is not enough to demonstrate the solution's theoretical value; it is also necessary to verify that the expected outcomes are confirmed in routine clinical practice under real-world conditions. This makes collaborative models between healthcare organizations and economic operators particularly valuable. Such partnerships can support the innovation process, facilitate data collection, define key performance indicators (KPIs), and, only at a later stage, build a genuine Value-Based Procurement model capable of consolidating and scaling solutions that have demonstrated their effectiveness.
A second issue concerns who should lead these processes within a procurement system structured across multiple levels, where national and regional purchasing bodies operate alongside healthcare organizations and hospitals. VBP necessarily requires strong involvement from healthcare organizations. Clinical leadership is essential to assess the real contribution of innovation and, more broadly, because healthcare organizations are ultimately responsible for delivering services to citizens. Without this involvement, there is a risk of purchasing solutions that, on the one hand, fail to gain acceptance among the professionals expected to use them and, on the other, lack the organizational environment needed to generate the anticipated benefits.
This does not mean that healthcare organizations must necessarily manage every procurement procedure directly. On the contrary, the role of centralized purchasing bodies could become even more important, provided they act as centers of expertise: offering technical support for procurement procedures initiated by healthcare organizations, collecting and monitoring the outcomes of pilot projects, and using this evidence to design increasingly effective procurement procedures at the regional level. The key issue, therefore, is not which institutional level should prevail, but where the necessary expertise, organizational maturity, and leadership exist to drive innovation.
Although some organizations consider themselves ready, the system as a whole has not yet reached an adequate level of maturity. At this stage, the most advanced organizations therefore play a decisive role by testing new models and paving the way for others. Their expertise and leadership are essential to overcoming two longstanding characteristics of the procurement function: the tendency to replicate established models and a strong aversion to risk.
The barriers that must be overcome
Among the most significant obstacles highlighted during the discussion is the limited digital maturity of many healthcare organizations. The challenge is not so much the availability of data as the ability to collect, integrate, and use it to define precisely the value expected from a technology and translate that value into procurement requirements that suppliers can clearly understand. In other words, a common language is still missing between what hospitals measure and what companies are able to demonstrate.
Moreover, the General Data Protection Regulation (GDPR) is not perceived as a major obstacle when information remains within the hospital. The real challenges stem from data governance and interoperability rather than from the European regulatory framework itself.
Another critical issue concerns institutional stability. Healthcare budgets are under increasing pressure, while the clinical and economic benefits of innovative technologies often emerge only over the medium to long term. This creates a misalignment between the time when investments are made and the time when their benefits are realized. In addition, designing new models of care requires time, a horizon that rarely aligns with political and administrative terms of office. This makes the role of intermediary institutions, such as academia, particularly important. They can provide methodological continuity and ensure knowledge transfer from one institutional cycle to the next, maintaining a consistent direction for change.
The combination of limited resources, long investment payback periods, traditional reimbursement models, and efficiency targets that are increasingly focused on the short term makes the adoption of VBP particularly challenging, especially in its early stages, when pilot projects require time before producing measurable results. This is compounded by the lack of a common framework linking public policy and procurement models. It would therefore be worthwhile to assess whether the new European regulatory framework for public procurement could introduce specific incentives to promote VBP and extend its application across different areas of the public sector.
European funding programs, which have already supported several pilot initiatives, should move in the same direction. Without a clear political commitment at the European level, however, there is a risk that VBP will remain the result of the efforts of a small number of particularly committed leaders rather than becoming a structural policy.
What tools are needed to expand VBP?
If VBP is to become standard practice, far more opportunities are needed for stakeholders across the European healthcare system to work together—not just exchange ideas. Practical settings are required where value-based procurement models can be tested in different contexts, results can be compared, and shared methodologies can gradually be developed. Likewise, investment is needed in joint training programs targeting different institutional levels and built around hands-on support for organizations as they conduct pilot projects.
Procurement can no longer be viewed as an isolated function that intervenes only at the final stage of the purchasing process. It must be involved from the outset, alongside clinicians, healthcare executives, procurement professionals, IT departments, and institutional decision-makers, so that the definition of value is shared and informs the entire decision-making process.
Suppliers must also change their approach
The transformation also affects supplier companies. For many businesses, a cultural shift is required—one that moves beyond the logic of annual budgets and short-term performance. A VBP project takes much longer than a traditional procurement process: it may require as much as three years to build a pathway that is genuinely focused on value, while companies' internal expectations often remain centered on quarterly or annual results.
The change does not end with participation in the procurement process. After contract award, VBP requires continuous performance monitoring, systematic evidence collection, and an ongoing partnership between the healthcare organization and the supplier. The generation of scientific evidence—both clinical and economic—must also evolve. Evidence generation models can no longer be designed solely to meet regulatory requirements; they must also address the information needs of the healthcare organizations purchasing the technologies. This, once again, requires a shared understanding of what is meant by "value."
For this reason, it is essential to work through multidisciplinary teams in which clinical, managerial, technological, and procurement expertise interact on a continuous basis. Only by agreeing on what should be measured, how it should be measured, and which outcomes should be rewarded will it be possible to develop procurement models that are truly outcome-oriented. Value, in fact, can take many forms: improved clinical outcomes, greater organizational efficiency, increased productivity, better experiences for patients and healthcare professionals, and even environmental sustainability. The challenge is not to choose a single dimension of value but to make each one explicit and measurable.
Investing today to create tomorrow's value
VBP no longer belongs to the future. The experience gained in recent years demonstrates that a community of organizations is now ready to put it into practice. Grassroots initiatives have played a vital role in developing expertise, testing new models, and demonstrating their feasibility. Today, however, they appear to have reached the limits of their ability to transform the system.
One of the most effective remarks made during the discussion organized by MedTech Europe captures this reality well: "Buying value is a marathon, but we don't have enough oxygen to reach the finish line and realize its benefits."
For VBP to become standard practice, local innovation must be complemented by institutional leadership capable of ensuring political continuity, sustained investment, and an enabling policy framework over time.
