Escore de Valor em Saúde (EVS): Uma proposta para mensuração de valor dentro de um sistema de saúde / Value-based Health Care Score (EVS): A proposal for measuring value within a health system

Um sistema de saúde baseado em valor deverá entregar os melhores desfechos possíveis ao paciente, desfechos que realmente importam para ele, ao menor custo possível. O conceito é relativamente fácil de entender, mas a métrica para a sua demonstração tem sido um grande desafio dos sistemas de saúde. O presente artigo demostra a criação de um Escore de Valor em Saúde (EVS) utilizando Análise de Decisão por Multicritério, o qual pode ser aplicado em qualquer sistema de saúde para avaliar profissionais, serviços de saúde e linhas de cuidado de pacientes com condições clínicas específicas.

A value-based healthcare system must deliver the best possible patient outcomes, outcomes that really matter to the patient, at the lowest possible cost. The concept is relatively easy to understand, but the metric to demonstrate it has been a major challenge for healthcare systems. This article demonstrates the creation of a Health-Based Health Care Score (EVS) using Multi-Criteria Decision Analysis which can be applied in any health system to evaluate professionals, healthcare providers and care pathways for patients with a specific disease.

Oportunidades e desafios da saúde baseada em valor: como o Brasil pode aprender com a experiência dos Estados Unidos / Opportunities and challenges of value-based healthcare: how Brazil can learn from the United States' experience

O movimento em direção à saúde baseada em valor é uma evolução que ocorre em muitas nações do mundo. O crescimento populacional, o aumento da expectativa de vida e o custo crescente com uma saúde de alta tecnologia exigem que os pagadores públicos e privados de todo o mundo criem novas maneiras de garantir que os gastos com saúde sejam feitos nas intervenções de maior impacto. Nesse ponto de vista, apresentamos o caso da transformação da saúde baseada em valor, que está atualmente em sua infância no Brasil. O Brasil possui pagadores públicos e privados e ainda paga os serviços na maioria das vezes no modelo de pagamento por procedimento. Comparamos isso com a experiência recente nos Estados Unidos, onde a saúde baseada em valor está, de maneira lenta, mas segura, se tornando a norma. O Sistema de Saúde Brasileiro tem muitas oportunidades de aprender com a mudança ocorrida nos EUA para um modelo de saúde baseado em valor ­ incluindo o desenvolvimento de medidas de qualidade, a transição para pagamento baseado em valor e a melhoria dos dados para avaliar o desempenho nos sistemas de saúde brasileiros. As indústrias de produtos farmacêuticos no Brasil também podem desempenhar um papel, com acordos baseados em valor e parcerias com pagadores. Cada nação seguirá seu próprio caminho para uma saúde baseada em valor, mas a oportunidade de aprender um com o outro possibilita melhores chances de sucesso.

The movement toward value-based care is an evolution occurring in many nations of the world. The increasing population, longer life expectancy, and rising cost for high-tech care necessitates that government and private payers around the world devise new ways to ensure that healthcare dollars are spent on the most impactful interventions. In this viewpoint, we present the case of the value-based care transformation that is currently in its infancy in Brazil. Brazil has a mix of private and public payers but still largely reimburses based on a fee-for-service model. We contrast that with recent experience in the United States, where value-based care is slowly but surely becoming the norm. The Brazilian system has many opportunities to learn from the US shift to value-based care ­ including the development of quality measures, transition to value-based payment, and leveraging data to rank performance across Brazilian health systems. Pharmaceutical manufacturers in Brazil can play a role as well, with value-based agreements and partnerships with payers. Each nation will travel on its own path to value-based healthcare, but the opportunity to learn from each other presents one of the best chances for success.

Opportunities and Challenges of Value-Based Health Care: How Brazil Can Learn from U.S. Experience.

The movement toward value-based care is occurring in many countries of the world. The increasing population, longer life expectancy, and rising cost for high-tech care necessitates that government and private payers around the world devise new ways to ensure that health care dollars are spent on the most effective interventions. In this Viewpoints article, we present the value-based care transformation that is currently in its infancy in Brazil, which has a mix of private and public payers but still largely reimburses based on a fee-for-service model. We contrast that with recent experience in the United States, where value-based care is slowly but surely becoming the norm. The Brazilian system has many opportunities to learn from the U.S. shift to value-based care-including the development of quality measures, transition to value-based payment, and leveraging data to rank performance across Brazilian health systems. Pharmaceutical manufacturers in Brazil can play a role, as well, with value-based agreements and partnerships with payers. Each country will travel on its own path to value-based health care, but the opportunity to learn from each other presents one of the best chances for success. DISCLOSURES: Abicalaffe received funding from Janssen Latin America for the preparation of this manuscript. Schafer is employed by Precision Value, a marketing agency that works with pharmaceutical manufacturers.

HTA Implementation in Latin American Countries: Comparison of Current and Preferred Status.

OBJECTIVES: To provide an overview about the current status of health technology assessment (HTA) implementation in Latin American countries and to identify long-term objectives considering regional commonalities. METHODS: We conducted a survey among participants of the 5th Latin American Future Trends Conference in October 2015. Thirty-seven respondents from eight Latin American countries provided insights about the current and preferred future status of HTA implementation related to human capacity building, HTA financing, process and organizational structure for HTA, scope of mandatory HTA, decision criteria, standardization of HTA methodology, mandating the use of local data, and international collaboration in HTA. RESULTS: Survey respondents reported insufficient human resources and public investment for HTA implementation. Organizational structure and legislation framework of HTA differ considerably across countries. According to survey respondents, in the future policymakers should rely more on the assessment of therapeutic value, cost-effectiveness, and budget impact criteria by applying explicit thresholds, potentially in a multicriteria decision analysis framework. HTA should not be restricted to policy decisions of new technologies but it should also be used for the revision of previous decisions. In addition, the quality and transparency of HTA have to be strengthened. CONCLUSIONS: HTA plays an increasingly important role in Latin American countries. Each country needs to record its current implementation status and identify components for improvement. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation.