• Ana Paula Etges

Proposition of a VBHC program for public and supplementary health systems in Brazil

Atualizado: Ago 20

Principal researchers: Carisi Anne Polanczyk and Ana Paula Beck da Silva Etges Researchers: Sheila Cristina Ouriques Martins, Bruna Stella Zanotto, Ana Claudia de Souza, Leonardo Alves Ogliari, Luciane Nascimento Cruz, Eduardo Gabriel Cortes, Avner Dal Bosco and Ricardo Cardoso

A research funded by the Brazilian Health Institute for Technology Assessment, IATS/CNPq


This research is unprecedented in Brazil in discussing the feasibility of making value-oriented priority care lines and has the potential to contribute, on a national scale, to value-based health-care management programs. It aims to propose a value-based health care model for supplementary and public health systems that could support management and health reimbursement practices. The study is fragmented in the stages: development of a method for assessing the quality of delivery of the health service and outcomes; development of a real cost monitoring tool based on time-driven activity-based costing; and proposing the operationalization of a value-based management model for supplementary and public health systems.

The ischemic stroke clinical pathway was defined as an object of study, and hospitals that operate in the public and supplementary systems and are members of the national stroke network (Rede AVC Brasil) were invited to compose the sample of institutions that will have their financial data and patient outcomes analyzed retrospectively.

The patient sample will consist of all patients undergoing treatment for ischemic stroke over six months between the years 2018 and 2019 in each of the hospitals, with a total of 950 patients estimated. The outcome identification step was based on a literature review, including ICHOM standard stroke set and specific studies discussing stroke outcomes, followed by discussion with experts. The outcomes identified were classified into three categories of variables: structure (safe and effective service), process (clinical management and treatment process), and clinical (Rankin, self-care, communication, and cognitive capability) and a total of 25 outcomes variable was already identified. A spreadsheet was built for the Python algorithms training process, and a multidisciplinary team is working on extracting structured information from EMR using supervised machine learning approaches. The final outcome will be measured in a number between 0 and 1 which represent a unique consolidated result from the performance achieved in each outcome variable. The Time-driven Activity-based Costing was defined for the micro-costing studies, and a math rule will be applied to normalize cost data and achieve a number between 0 and 1 that represents high or lower costs. The division of outcomes and costs will measure the value achieved in each institution. The benchmark will be identified as the highest value identified, and the incremental value between institutions will be evaluated by dividing the value of each institution by the benchmark. This result will be used to orient reimbursement policies and to apply regression models that can identify the outcome variable or cost activity where the hospital may focus improvement actions on increasing value. The union of the first steps will allow the proposition of the value-based health management model, which will be documented in 2 value frameworks, one for the public health system and the other for supplementary. The proposal of the model accompanied by the intelligence of data collection and analysis is understood as a way to make it possible to implement value-based health management practices in scale in Brazil.

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