OBJECTIVE: Brazilian National Agency for private healthcare system (ANS) makes the regulation for private healthcare system in Brazil. ANS, since 2019, is running the pilot value-based new payment models project. In total, 13 projects were selected by ANS. The goals of this analysis are to identify key operationalization process challenges for implementing new value-based payments models in Brazil, according with the managers of private healthcare plans participating in the projects. METHODOLOGY: We interviewed managers participating in the Value-Based Payment Models by ANS. Data collection was through semi-structured interviews carried out during 2021. 12 managers were invited to participate in the interview, being applied with 8 managers. The key questions were: “Was there a need for internal alignments? / What were the key steps and areas involved for external alignments? " For data analysis, Bardin's content analysis was chosen. Data validation was performed using the defriefing technique.

RESULTS: The key elements identified were related with project construction processes: 23% reported 1) challenges (difficulties) with a) healthcare services providers (52%), including negotiating and mindset change, b) IT management (38%), including integrating the ANS claims database with health plan database, c) Agreement with service providers (10%). In more details, 2) the alignment with the provider is related to the team (54%) and process (46%). Furthermore, 3) 21% mentioned a positive perceptions about the project, including the focus on patients (35%) and support from ANS (23%)., Also, 15% referred to the needs of the projects, including processes (32%) – regulation and auditing, culture (26%) – paradigm shift, people (26%) – knowledge and support from board of director, and investment (16%). Finally, 15% referred the internal alignments with the team: administrative (58%) and care (42%). CONCLUSION: Our research suggests that the alignment with the provider and IT structure are the most sensitive areas.