What Is a Value Management Office? An Implementation Experience in Latin America

Makdisse, Márcia; Katz, Marcelo; Ramos, Pedro; Pereira, Adriano José; Shiramizo, Sandra Christina Pereira Lima; Neto, Miguel Cendoroglo; Klajner, Sidney

doi:10.1016/j.vhri.2018.02.002

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…While the pioneering work on VBHC has informed a range of health policies across the globe [9][10][11][12], the actual reorganization into value-based hospital structures remains unclear and understudied [10,13,14]. This study aims to provide a deeper understanding of how hospitals realign their organizational structure with the creation of value for patients.…”

Section: Introductionmentioning

confidence: 99%

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

Steinmann

Daniels

Mieris

et al. 2022

BMC Health Serv Res

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Background A crucial component of value-based health care concerns the redesign of organizational structures. In theory, hospital structures should follow value creation: addressing medical conditions for specific groups of patients over full cycles of care. In practice, however, it remains unclear how hospitals can reorganize themselves into value-based structures. The purpose of this study is to explore the ways in which Dutch hospitals are currently implementing and pursuing value-based redesign. Methods This qualitative exploratory study used semi-structured interviews and a focus group for data collection. Transcripts were analyzed through deductive coding, for which we used Mintzberg’s theory on organizational structures, particularly his work on design parameters. Results In their efforts to create more value-based structures, Dutch hospitals often employ a variety of liaison devices, such as project teams and committees. By contrast, the actual formation of units around medical conditions is much rarer. Outcome data are widely used within planning and control systems, and some hospitals partake in external benchmarking. Not all hospitals use cost indicators for monitoring performance. Conclusions Value-based redesign is not necessarily a matter of radical changes or binary choices. Instead, as Dutch hospitals show, it can be an incremental process, with a variety of potential knobs to turn to various degrees. Health care executives, managers, and professionals thus have a wide range of options when they aim for more value-based structures. Our conceptualization of “value-based design parameters” can help guide the selection and implementation of strategies and mechanisms for further coordination around medical conditions over full cycles of care.

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Section: Introductionmentioning

confidence: 99%

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

Steinmann

Daniels

Mieris

et al. 2022

BMC Health Serv Res

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“…Previous research evaluating the diffusion of Porter and Teisberg's theoretical concepts found conceptual confusion on key value-related concepts 2 ; the fact that we did not find as much conceptual confusion among our physicians may be due to the high visibility that VBHC has gained in the Brazilian private healthcare market in the past 2 years and specifically at our organization, to the implementation of a dedicated value management office that has been working in close connection with physicians from different specialties in the creation of new condition-based bundle payments, and to holding internal and external meetings that bring together different stakeholders for discussing and disseminating VBHC initiatives. 9 One other possible explanation for the smaller conceptual confusion (and even our high sample size) is the robust physician relationship program in place for about a decade that helps to engage and unify a large open physician group that interacts on several regular forums the hospital promotes.…”

Section: Discussionmentioning

confidence: 99%

“…The private face of Einstein operates under an open physician staff model, which means that most doctors (83%) are not directly employed by the hospital; instead, they have to go through a registration process to practice at the organization. 9 The relationship between Einstein and its clinical staff has evolved since the organization's foundation in 1971. The initial practice was that the president himself would invite young physicians to work at the hospital; with increasing accreditation and quality requirements, a framework for physician registration and confirmation of their qualification and skills was created in the 1990s.…”

Section: The Context Brazilian 2-tiered Healthcarementioning

confidence: 99%

What Do Doctors Think About Value-Based Healthcare? A Survey of Practicing Physicians in a Private Healthcare Provider in Brazil

Makdisse

Ramos

Malheiro

et al. 2020

Value in Health Regional Issues

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“…The EIU study, however, focused on the macrolevel evaluation of health systems. More recent reports from leading Latin American healthcare organisations have shown an emerging movement around the implementation of alternatives to FFS payments, more integrated care models, monitoring of outcomes and costs using the International Consortium for Health Outcomes Measurement (ICHOM) standard sets and time-driven activity-based costing (TDABC) 8–11. These experiences by front-runner organisations may serve as a benchmark for other organisations in the region initiating similar endeavours.…”

Section: Introductionmentioning

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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What Is a Value Management Office? An Implementation Experience in Latin America

Cited by 7 publications

References 13 publications

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

What Do Doctors Think About Value-Based Healthcare? A Survey of Practicing Physicians in a Private Healthcare Provider in Brazil

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

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