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

<p><span><b>Objectives</b></span></p> <p><span>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.</span></p> <p><span><b>Design</b></span></p> <p><span>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.</span></p> <p><span><b>Participants </b></span></p> <p><span>Top and middle-level executives from 70 healthcare provider organizations from Argentina, Brazil, Chile, Colombia and Mexico. </span></p> <p><span><b>Results </b></span></p> <p><span>From a total<b> </b>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&lt;0,01) and outcomes measurement (p=0.01), implementation of ICHOM standard sets (p&lt;0.01), and participation in alternative payment models were associated with VBHC implementation (p=0.01). </span></p> <p><span><b>Conclusions</b><b> </b></span></p> <p><span>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. </span></p>