A collaboration between Einstein Hospital in Brazil and Medtronic is designed to help the transition to value-based care by tracking and analyzing outcomes to determine value.


Analyzing and discussing data

Citizens are increasingly demanding access to improved medical advances and quality of life. But it is harder to put the puzzle together when the pieces represent the demands of all the players involved: governments, insurance companies, healthcare clinicians, and patients. How can we focus on the wellbeing of those who suffer to prevent chronic conditions without emptying their pockets? The Albert Einstein Hospital in São Paulo, Brazil found a solution.

The key to the new model is not only reducing the costs of services and technologies, but also focusing on what matters most to patients and charging for real results. “Pay only if it works,” implies a revolution that is just starting in Latin America. And it promises to benefit patients — at the center of everyone's interests — as well as shaky healthcare systems in the region.


Value-based healthcare (VBHC) was the model Michael Porter, an economist at Harvard Business School, proposed more than a decade ago. And it’s this same model that leading countries are adopting to solve the perfect storm afflicting their healthcare systems.

The prestigious Albert Einstein Hospital has also undertaken this journey. Instead of charging for each consultation, imaging, laboratory test, or surgery, this large hospital system — in charge of managing dozens of public and private health centers — made the decision to start charging for the complete cycle of care, based on clinical results, as well as (levels) of patient satisfaction and quality of life achieved.

“The current payment model incentivizes recruiting more patients and doing more procedures, but it is not sustainable,” said surgeon Sidney Klajner, president of Einstein Hospital and pioneer of this change. “The value model focuses on avoiding waste (stemming from unnecessary procedures, complications, and readmissions) and increasing quality and safety.”

The president of this hospital — a private, non-profit organization established by the Albert Einstein Israeli Charitable Society more than 60 years ago — knows this transformation comes with challenges. But Klajner is certain about what needs to be measured accurately — the value of healthcare being provided to patients during visits and later billed to insurance companies, governments, and patients.

In 2013, Einstein began working with doctor-led multidisciplinary groups grouped by medical condition or therapy (obesity and metabolic risk, movement disorders, and others). Currently, more than 900 doctors participate in such groups known as “GMAs” (Grupos Médicos Assistenciais or Medical Care Groups in English). In addition, the hospital trains medical students on the concept of value. “The challenge lies with the doctors,” admits Klajner. “We must make it attractive enough for them not to merely focus on charging for the services they provide but also on a commitment to good health, prevention, and the values that are important to each patient.”

“Value varies from patient to patient and from population to population,” Klajner added. "For some, it may be about preventing disease and, for others, about reducing their co-payments or receiving a better treatment. In such a complex system with so many stakeholders, questionnaires allow us to understand what patients value.”


To expand this new culture and standardize findings, Einstein Hospital has been focused on keeping track of results. In February 2017, they created the Value Management Office (VMO), a central office with dedicated personnel that integrate various sources of information, from electronic medical records to outcomes and financing. The information is loaded into a Business Intelligence platform so that patient- and physician-level analysis can be performed for medical conditions over the cycle of care.

“The mission of VMO is to implement the new agenda throughout the hospital and to apply it within the clinical context of Latin America, so payers will agree to change the fee-for-service model to this new model,” explained Marcia Makdisse, VMO manager, cardiologist, MBA, and manager of the Medical Practice Division.

According to Makdisse, the first successful experience was in back-pain surgery. Through the “Second Opinion” program, they offered rehabilitation services to patients during referral visits and established clear criteria for interventions. This benefited patients and helped insurance companies avoid payments for thousands of surgeries. “We want to apply this model to other medical conditions,” said an enthusiastic Makdisse, who manages the outcomes of 29 conditions, 7 already based on the standards of the International Consortium for Health Outcomes Measurement (ICHOM).

To calculate the value of each treatment cycle, experts at Einstein Hospital measure three types of outcomes:

  1. Clinical outcomes (mortality, readmissions, infection rates)
  2. Patient-reported outcome measures (patient functioning levels and quality of life)
  3. Patient-reported experience measures (patient perceptions based on questionnaires, such as the net promoter score).

Results are entered into a computer platform that will soon allow user interaction via cell phones.


“We have to change from a volume culture to a value culture — improving healthcare and technology efficiencies, without compromising people´s safety,” underscored Makdisse. “The value model means better care and diagnosis, as well as lower costs and reduced waste.”

This new path is gaining more momentum. “We have established our own Value Office and our own initiatives, and we have found a common vision with Medtronic, so we want to develop projects together,” says Klajner. Pilot projects will center on diabetes, aortic stenosis, and coronary heart disease.

Inspired by the Medtronic Diabetic Clinic in the Netherlands, Einstein Hospital will apply the model through a program to educate, diagnose, and treat diabetes for all its employees and their families (a population of 27,000 individuals). “This is a collaborative effort between Einstein and Medtronic, where we have already started building a pay-per-care-cycle model (bundles),” added Makdisse.

If the program works, Einstein will offer it to additional clinicians in Brazil and will create alliances with hospitals in Latin America. “There is no single model of care that fits everyone,” clarified Klajner. “But I have experienced the concepts of value, quality, and sustainability in my own practice, so I am committed to extending them, not only for the benefit of patients in our hospital, but also to improve the health of all Brazilians — a core element to Einstein's mission."