Ensuring access to quality treatment options which meet the diverse needs of patients is paramount. As such, interest in agreements linking outcomes with payment is growing across stakeholder groups. Currently, available literature focuses primarily on the outlook, trends and challenges; here, key considerations for engagement are shared. Outcomes-based agreements may be implemented between diverse healthcare stakeholders, e.g. health plan and manufacturer, in order to increase alignment on value, accountability, and risk mitigation regarding real-world effectiveness of a treatment. Thoughtful agreements, executed well, may enhance mutual stakeholder benefit for partners, providers and patients. Performance is measured in a defined cohort over a finite period of time using a key outcome; this outcome, indicating effectiveness, may be observed via reductions in clinical events or healthcare resource utilization or may be inferred by use of an established proxy (e.g. therapeutic compliance). The key outcome should resonate with both partners (e.g. tie to quality / performance measures). Value-based payments are dependent on measured performance vs. contractual metrics. Shared objectives, clear incentives, availability and quality of required data, and committed resources are important factors in securing interest and appropriate partners. The following elements are also critical to address: outcomes-based benefit design (standalone / supplemental to formulary access), applicable patient segment, analytic resources and support, timing, format and utilization of results, associated communications, and anticipated touchpoints. A comprehensive and pragmatic analytic roadmap guiding the outcome evaluation should be in place, detailing data elements and metrics involved in reporting. Ongoing dialogue, collaboration and transparency to ensure mutual understanding, efficiencies, and successful progression are integral. These elements are essential to increase success. The relationship that is often built simultaneously provides an opportunity to strengthen foundational understanding and ties between diverse stakeholders in the direction of common healthcare goals and additional innovative solutions.