IntroductionThe Brazilian National Agency for private healthcare system (ANS) makes the regulation for private healthcare system in Brazil. ANS, since 2019, is running the pilot value-based new payment models project. In total, 13 projects were selected by ANS. This research aims to identify the key drivers for moving from fee for service (FFS) to value-based payment models in the Brazilian healthcare private system.MethodsWe interviewed managers of private healthcare plans (13 in total) participating in the Value-Based Payment Models run by ANS. Data were collected through semi-structured interviews during 2021. Twelve managers were invited to the interview and eight accepted the invitation. The key questions were: “Why are healthcare providers transitioning from the fee for service model to value-based models?” and “What are your motivations to participate in the ANS project?” For data analysis, Bardin’s content analysis was chosen. Data validation was performed using the debriefing technique.ResultsThe main reasons for transitioning from FFS to value-based models were related to weaknesses of FFS (58%), strengths of the value-based payment model (14%) and sector needs (14%). Fee-for-service weaknesses are related to financial impacts – including waste and unsustainability (55%), and lack of transparency – including lack of trust and conflict of interest (28%). Strengths of the value-based payment model were related to financial benefits (100%), in other words, greater return on investment. The key unmet needs of the sector are related to improvement of the financial status - including lower costs and less waste (71%), and improvement of care delivery quality (29%). Continuity was reported as a benefit of FFS, according to 43 percent of respondents.ConclusionsOur results suggest that financial motivations are the main reason to transition from fee-for-service to value-based models.

IntroductionThe Brazilian National Agency for private healthcare system (ANS) regulates the private healthcare system in Brazil. ANS, since 2019, has been running the pilot value-based new payment models project. In total, 13 projects were selected by ANS. This investigation aims to identify opportunities and challenges to implement value based healthcare (VBHC) in Brazil.MethodsWe interviewed managers participating in the ANS’ Value-Based Payment Models. Data were collected through semi-structured interviews during 2021. Twelve managers were invited to participate in the interview and eight accepted the invitation. The key questions were: “what are the main factors that facilitate – or limit - the transition from the fee for service model to a value-based model in the private healthcare system? And “will the payment models be scalable?” For data analysis, Bardin’s content analysis was chosen. Data validation was performed using the debriefings technique.ResultsThe interviews identified two key facilitating factors: people (identified by 50% of respondents) and processes (identified by 50% of respondents). Reponses relating to people nominated the need for professionals with VBHC knowledge (33%), support of senior management (25%), support from the provider (25%) and care team (17%). Reponses relating to processes nominated the need for partnership (58%), health-driven management (25%) and results (17%). We also identified that limiting factors (49%) were: providers (39%), in details: non-support from the provider, (56%), fear of financial loss (22%) and provider only wanting profit (22%); information system (30%), with data management; culture (17%), current versus innovative models; and peoples (13%), knowledge. More than 90 percent found it to be scalable, particularly, in vertical health plans (38%), large operators (38%); and provide diagnostic services (13%). We found that non-scalable situations are those where fee for service is hegemonic in terms of payments.ConclusionsOur study found that knowledge and culture management positively impacts the projects. Service providers can be limiting when they are exclusively focused on economic perspectives. The new payment model is considered scalable.

Value-based healthcare (VBHC) é um modelo que busca recompensar prestadores e tecnologias capazes de entregar resultados que agreguem valor para o paciente, de forma a otimizar a sustentabilidade na saúde. O objetivo deste trabalho foi identificar as percepções de médicos, gestores e representantes da indústria farmacêutica acerca dos conceitos relacionados a VBHC.  Foram entrevistados stakeholders de diversas áreas dos sistemas de saúde brasileiro entre dezembro de 2018 e março de 2019 acerca de suas percepções em diferentes domínios relacionados à estrutura organizacional, gestão e gestão baseada em valor. De 100 stakeholders contatados, 36 responderam aos questionários. Referente ao domínio organizacional, os itens com maior concordância foram o acompanhamento de protocolos clínicos e custos associados a eles (mediana 8,0) e modelos aplicados a novas práticas de remuneração por performance entre prestadores e operadora de plano de saúde (OPS) são de interesse da empresa (8,0). Relativo a quais itens são importantes para o processo de gestão da empresa, destacaram-se o impacto financeiro de novas incorporações, os comparadores clínicos, econômicos e financeiros entre as tecnologias de mesmo protocolo clínico, a melhoria da qualidade da atenção médica e o acompanhamento econômico de efeitos adversos, todos com mediana 10,0. Por fim, para o domínio de saúde baseada em valor, destacam-se o acompanhamento de desfechos clínicos dos pacientes, os dados de custo-efetividade, a satisfação do paciente, a melhoria qualidade da atenção médica e o acompanhamento clínico e econômico de efeitos adversos, todos com mediana 10,0. Enquanto alguns stakeholders estão atentos em oferecer mais qualidade e já estão atentos à geração de valor em saúde outros estão sensíveis principalmente à questão de redução de custos especialmente. Para esse último grupo, é fundamental compreender em detalhe sua realidade e explicitar como a saúde baseada em valor agrega a esse cenário condicionando aumento de gastos com maior entrega de saúde. Incluir e engajar todos os atores do sistema de saúde para promover uma visão conjunta de valor e eficiência é um fator condicionante ao sucesso da implantação de modelos de saúde baseada em valor.

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