VALUE-BASED PROGRAMS Aligning Value

Developing VBHC models for Latin America and elsewhere

   

Doctor with patients

In a nutshell, today’s global healthcare systems are focused on reducing the cost of care while maintaining or improving clinical outcomes and quality. Medtronic is playing a leading role in working with healthcare clinicians and payers to better align incentives and build more sustainable, value-based models of care.

Jason Arora, Medtronic director of value-based healthcare (VBHC) for Latin America, recognizes the challenge of stretching limited resources to provide healthcare to everyone. “That is not an easy task,” he emphasizes, “We need to be creative.” For him, VBHC is one of the best ways system stakeholders can tackle the resource, quality, and access problems in healthcare.

LATIN AMERICA — THE CHALLENGES AND THE SOLUTION

According to Arora, Latin America is more in need of VBHC than many other regions “Here, we face a dual-disease burden — communicable and non-communicable chronic disease. We often face larger shortfalls between resources and needs, quality is extremely variable, geographical and economic access barriers are rife, and so on.” VBHC could very well be the elixir that Latin America’s healthcare system needs.

At the simplest level, a healthcare system has the same basic building blocks. Given the numerous successes in VBHC implementation globally, Medtronic is optimistic about adapting and replicating these models in Latin America, despite existing challenges:

  • Payers may be unwilling to pay for outcomes/value rather than volume, despite a clear benefit to them in a value-based system.
  • IT and data systems are unstructured or non-existent (although sophisticated IT systems are not required to measure outcomes and costs accurately).
  • Healthcare stakeholders don't trust or are unwilling to partner with each other (payers, clinicians, governments).
  • A desire to “do things the old way” leads to attrition and a lack of progress.

Nevertheless, these challenges are not specific to Latin America, and none of them have proven insurmountable elsewhere.


VBHC could very well be the elixir that Latin America’s healthcare system needs.


MEDTRONIC VBHC PROGRAM OFFERINGS

Medtronic is developing and refining a strong portfolio of VBHC programs centered on the company’s therapies. “The VBHC programs are a list of VBHC models, across different therapy areas that have been built and verified by our therapy, economic, VBHC, and other subject matter experts,” explains Arora.

To develop these programs, Medtronic has a methodology that addresses all key aspects of a VBHC model of this nature, including:

  • Patient cohort selection
  • Outcomes selection
  • Value objectives determination

Importantly, determining each of the VBHC program details is evidence-based and involves the consideration and analysis of high-quality data.

According to Arora, the VBHC program offering provides verified blueprints that can be adapted to local contexts. In other words, much of the work in building these models has already been done. “Our job, locally, is then to work with local data and evidence to tweak the model." (In some situations, baseline data may be significantly different, which will likely impact the objectives of the program, e.g. two care pathways may be different, impacting patient cohort selection.) “Regardless, the overall model may not change significantly,” he added.

CONTINUOUS DEVELOPMENT OF VBHC MODELS

Even when the VBHC programs have proven to be successful and have already provided several case studies, Medtronic understands the need for flexibility. “It really depends on the scenario. For example, if a care pathway for a given disease is significantly different in a local market, we may have to build an entirely new model, using only elements of an established VBHC program. That said, these provide us with a starting point,” explained Arora. In this sense, Medtronic is continuously developing new models based on field work. The result is a fast-growing inventory of VBHC models, some of which will be successful, and some of which will not. Like all in the VBHC world, we are learning as we go along.


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