DOI: 10.5061/dryad.83bk3j9sc
title: VBHC in Latin America: A survey of 70 healthcare provider organizations

description: 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&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). 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.
description: 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.
description: 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.