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.

Mixed-methods research combining both qualitative and quantitative techniques were used. Quantitative methods included an online questionnaire to assess the level of implementation of the value agenda components and to map VBHC initiatives, and analyses of aggregated data on the initiatives referred in the interview. Qualitative methods included semi-structured interviews and analysis of relevant documents, including meeting notes and published documents. Online surveys and interviews were applied between December of 2018 and June of 2020.

From a total of 182 organizations considered to participate in the study, 71 signed the written consent. Two organizations requested to participate as a single organization, as they work as a single management and care provider, which resulted in a final sample of 70 participants. 

Quantitative and qualitative data were analyzed using descriptive statistics. Fisher's exact test was performed to compare organizations that had implemented VBHC initiatives with those that had not implemented. Univariate analysis was used to identify differences between the two groups in relation to VBHC implementation.

To compare organizations regarding their level of alignment with the value agenda, answers to the online survey were transformed into binary variables, where ‘yes’ (high level of alignment) was considered if options ‘a or b’ had been selected, and ‘no’ (low level of alignment) for all other options.

To keep data anonymized all information regarding country, size, and organization profiles were also turned into binary variables.

A dictionary of terms to describe variables is available as part of the spreadsheet.