PNS72 From Volume-to-VALUE in Latin America: A 6-STEP Process

Abstract

Outline the experience with value-based healthcare (VBHC) in Latin America (LA), define local hurdles to implementation of VBHC, and propose a 6-step process to support institutions transition from volume-to-value payment models. In-depth secondary research identified regional and global benchmarks of VBHC, LA-specific hurdles to implementation and enablers for successful execution. Secondary research findings were validated through in-depth discussions with 5 local experts in Argentina, Brazil, Chile, Colombia, and Mexico. VBHC has the triple aim of lowering costs, improving health, and bettering patient experiences. However, the transition from a well-established fee-for-service to a fee-for-value model is logistically complex and will take time. In LA, experience with VBHC is scarce. Only in Chile and Colombia can the presence of enabling elements for VBHC, such as bundled payments or pay-for-performance (Chile) and quality standardization (Colombia), be nationally identified. In addition, only one executed pilot of a comprehensive VBHC model has been identified with the ‘Albert Einstein Hospital’ in Brazil. Some of the LA-specific challenges faced in the in the transition to VBHC programs are subpar data analytics and information technology (IT) tools, lack of consistency in the care delivery process, aligning stakeholder incentives on quality and cost goals, and healthcare system fragmentation. A 6-step approach has been designed to support institutions transition from volume- to value-based payment models: (1) creating a migration plan, (2) educating and training internal stakeholders, (3) building a robust IT platform , (4) developing standardized care pathways with clear quality indicators, (5) measuring outcomes and costs, and (6) moving to value-based payment models (bundles, pay-for-performance, global capitation, shared savings). VBHC holds great potential, but in the volume to value transition, change is gradual. A 6-step process has been designed that LA institutions can follow to successfully migrate from fee-for-service to fee-for-value models.