It takes two to dance the VBHC tango: A multiple case study of the adoption of value-based strategies in Sweden and Brazil

Ramos, Pedro; Savage, Carl; Thor, Johan; Atun, Rifat; Carlsson, Karin Solberg; Makdisse, Márcia; Neto, Miguel Cendoroglo; Klajner, Sidney; Parini, Paolo; Mazzocato, Pamela

doi:10.1016/j.socscimed.2021.114145

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…It is clearly essential to know how patients define value, otherwise the risk exists that care development will focus on what is easy to measure instead of what is most important and of greatest value to the patients. Some major factors affecting the implementation of measuring outcome and cost are (i) data infrastructure, (ii) a systematic approach for the identification of improvement potential and the selection and implementation of improvement initiatives, (iii) governance in which roles and responsibilities of physicians regarding outcome improvement are formalized, and (iv) implementation of outcomes within hospital strategy, policy documents, and the planning and control cycle (Ahmed et al, 2019;Allen et al, 2021;Amini et al, 2021;Bodar et al, 2020;Colldén & Hellström, 2018;Cossio-Gil et al, 2022;Goretti et al, 2020;Kuklinski et al, 2020;Lansdaal et al, 2022;Marotta et al, 2020;Nilsson et al, 2017;Ramos et al, 2021;Rutherford et al, 2021;Schraut et al, 2022;St John et al, 2021;Van Veghel et al, 2020;Varela-Rodríguez et al, 2021;Zipfel et al, 2019). In moving to bundled payments, many current initiatives have been successfully centered on creating bundled payments for surgical care to reduce cost.…”

Section: Resultsmentioning

confidence: 99%

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Gunawan

Nadjib

Soraya

2022

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The medical cost trend had been increasing faster than the global inflation rate. Higher costs posed a significant problem for healthcare providers, payers, and eventually patients. The concept of value-based healthcare (VBHC), which emphasized the importance of measuring outcomes relative to the costs, was introduced to mitigate the impact of these medical trends. This research used a scoping review methodology to describe the factors that affect the shift from the conventional volume-based healthcare to value-based healthcare. Data of research based on article search was conducted using online Scopus and Embase databases, resulting in 800 articles describing value-based healthcare. Duplication removal excluded 76 articles, screening excluded 295 articles, eligibility assessment excluded 76 articles, and the remaining 30 articles were included. The results of study show that VBHC was proposed as a shift in healthcare management entailing six reinforcing elements, but most hospitals have implemented only one VBHC element. The most common implemented elements are “the measurement of outcome and cost” and “the reorganization to integrated practice units.” The key success for the implementation of these elements are: (1) strong data collection to measure clinical outcomes that matter to patients, (2) clear governance of this data management, and (3) strong support from the high leadership to encourage multidisciplinary teamwork. Thus, the true VBHC system can only be reached when all the six elements are achieved. However, no single study describes a success in implementing all elements of VBHC. Hospital leaders need to be cautious when interpreting VBHC as not to think that the VBHC can be reached by cherry-picking only selected elements of VBHC.

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Section: Resultsmentioning

confidence: 99%

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Gunawan

Nadjib

Soraya

2022

jss

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“…4 Doctors and executives were the most referenced stakeholders in terms of the buy-in process. Doctors as ‘team captains’ have a key role in IPU implementation and as a member of the multidisciplinary care team, 19 and quoting one of the interviewees (I_26) ‘ currently doctors are not educated on this and whoever is leading these processes of change is not involving physicians in such discussions.’…”

Section: Discussionmentioning

confidence: 99%

Value-based healthcare in Latin America: a survey of 70 healthcare provider organisations from Argentina, Brazil, Chile, Colombia and Mexico

et al. 2022

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ObjectivesValue-based healthcare (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 provider organisations (HPOs) level are lacking. This study aim was to investigate how HPOs in five Latin American countries are implementing VBHC.DesignMixed-methods research was conducted using online questionnaire, semistructured interviews based on selected elements of the value agenda (from December 2018 to June 2020), analyses of aggregated data and documents. Qualitative analysis was performed using NVivo QSR International, 1.6.1 (4830). Quantitative analysis used Fisher’s exact test. Univariate analysis was used to compare organisations in relation to the implementation of VBHC initiatives. A p≤0.05 was considered significant.ParticipantsTop and middle-level executives from 70 HPOs from Argentina, Brazil, Chile, Colombia and Mexico.ResultsThe definition of VBHC varied across participating organisations. Although the value equation had been cited by 24% of participants, its composition differed in most case from the original Equation. Most VBHC initiatives were related to care delivery organisation (56.9%) and outcomes measurement (22.4%) but in most cases, integrated practice unit features had not been fully developed and outcome data was not used to guide improvement. Information, stakeholders buy-in, compensation and fragmented care delivery were the most cited challenges to VBHC implementation. Fee-for-service predominated, although one-third of organisations were experimenting with alternative payment models.ConclusionsA wide variation in the definition and level of VBHC implementation existed across organisations. Our finding suggests investments in information systems and on education of key stakeholders will be key to foster VBHC implementation in the region. Further research is needed to identify successful implementation cases that may serve as regional benchmark for other Latin American organisations advancing with VBHC.

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“…Yet, the concept, as proposed by Porter and colleagues, is framed and described as a strategic vision without supplying specific guidance on how to proceed in practice. Moreover, actions needed for the implementation of VBC depend on the specific circumstances and prerequisites in the respective healthcare system [ 5 ]. As a result, approaches to implementation vary between healthcare systems and countries with best practices regarding specific characteristics of a health system remain largely unclear [ 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hence, acceptance of and attitude towards the concept among those stakeholders that are affected by system changes and involved in legislation is critical for the implementation of VBC. Even though the implementation of VBC is already being advanced in other countries [ 5 , 8 , 9 ] or at the supranational level [ 10 ], little knowledge exists on implementation specifically in the German context. The previous literature examined the German healthcare providers’ knowledge of VBC, but only focused on the hospital sector [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Transforming Health Care Delivery towards Value-Based Health Care in Germany: A Delphi Survey among Stakeholders

et al. 2023

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Value-based healthcare (VBC) represents one strategy to meet growing challenges in healthcare systems. To date, VBC is not implemented broadly in the German healthcare system. A Delphi survey was conducted to explore stakeholders’ perspectives on the relevance and feasibility of actions and practices related to the implementation of VBC in the German healthcare system. Panellists were selected using purposive sampling. Two iterative online survey rounds were conducted which were preceded by a literature search and semi-structured interviews. After two survey rounds, a consensus was reached on 95% of the items in terms of relevance and on 89% of the items regarding feasibility. The expert panels’ responses were in favor of the presented actions and practices of VBC in 98% of items for which consensus was found (n = 101). Opposition was present regarding the relevance of health care being provided preferably in one location for each indication. Additionally, the panel considered inter-sectoral joint budgets contingent on treatment outcomes achieved as not feasible. When planning the next steps in moving towards a value-based healthcare system, policymakers should take into account this study’s results on stakeholders’ perceptions of the relative importance and feasibility of VBC components. This ensures that regulatory changes are aligned with stakeholder values, facilitating greater acceptance and more successful implementation.

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It takes two to dance the VBHC tango: A multiple case study of the adoption of value-based strategies in Sweden and Brazil

Cited by 14 publications

References 18 publications

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Value-based healthcare in Latin America: a survey of 70 healthcare provider organisations from Argentina, Brazil, Chile, Colombia and Mexico

Transforming Health Care Delivery towards Value-Based Health Care in Germany: A Delphi Survey among Stakeholders

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