VBHC in Latin America: A survey of 70 healthcare provider organizations

Objectives Value-based Health Care (VBHC) is a health system reform
gradually being implemented in health systems worldwide. A previous
national-level survey has shown that Latin American countries were in the
early stages of alignment with VBHC. Data at the healthcare providers
level are lacking. This study aim was to investigate how healthcare
providers in five Latin American countries are implementing the Value
Agenda. Design Mixed-methods research was conducted using online
questionnaire, semi-structured interviews (from December of 2018 to June
of 2020), and  analyses of aggregated data and documents.
Statistical analysis was performed using Fisher's exact test.
Univariate analysis was used to compare organizations in relation to the
implementation of VBHC initiatives. P value ≤0.05 was considered
significant. Participants  Top and middle-level executives from
70 healthcare provider organizations from Argentina, Brazil, Chile,
Colombia and Mexico. Results From a total of 172 initiatives referred by
55 participants, 58 referred by 33 participants were aligned with the
value agenda and focused on care delivery organization (56.9%), outcomes
measurement (22.4%), cost measurement (10.3%) and bundled payments
(10.3%). Although fee-for-service predominated, one third of providers
were experimenting with alternative payment models. Univariate analysis
showed that specialty hospitals (p=0.05), a high level of alignment with
care delivery organization (p<0,01) and outcomes measurement
(p=0.01), implementation of ICHOM standard sets (p<0.01), and
participation in alternative payment models were associated with VBHC
implementation (p=0.01). Conclusions A wide variation in the level of
implementation of the value agenda existed across participating providers.
A list of initiatives was produced that may provide insights for different
stakeholders. Scalability of such initiatives will demand investments on
education of stakeholders and on systematic measurement and use of
outcomes and cost data. Further research is needed to identify successful
implementation cases that may serve as regional benchmark for other Latin
American providers advancing with VBHC.