Dr. Homero A. Monsanto (Chair, Industry Committee), Dr. Claudia Soares (Chair-Elect, Industry Committee), Dr. Hector Castro (Moderator, Head, Latam Health Policy Genentech/Roche and Former Chair of the Latin America Policy Forum, HTAi. Washington DC), Mr. Miguel Martin de Bustamante (Partner, Evidence, Value, Access & Pricing (EVAP), Emerging Markets / Latin America Lead, Trinity Lifesciences, San Francisco CA), Dr. Diego Guarin (Executive Director of Regional Market Access Latin America, Global Market Access, Merck & Co, Inc. and Co-Chair of the Value and Access to Innovation Working Group at FIFARMA, Kenilworth, NJ), Prof. Renata Gasparello (National Regulatory Agency for Private Health Insurance and Plan (ANS) and Universidade Católica de Petrópolis, Rio de Janeiro, Brazil)
On March 15, 2022, the ISPOR Latin America Consortium Industry Committee hosted a webinar aimed at discussing trends in the HTA/Reimbursement environment in Latin America and the drivers for value-based health care (VBHC) implementation within the region. Dr. Hector Castro moderated the session, setting the stage by presenting the updated definition of HTA and how this could potentially have reimbursement policy implications in Latin America.
Mr. Martin de Bustamante presented the evolution and status quo of HTA in decision-making across the region, discussed the role of HTA in enabling VBHC using some examples from the region, and highlighted existing limitations and potential factors to further enable the transition of VBHC in Latin America. He highlighted that, although several countries have established HTA bodies, implementation is not uniform across the region. He argued there is a role for HTA to support VBHC initiatives at national, sub-national and hospital-level in several countries but that there are specific actions that need to be taken to strengthen the role of HTA as an enabler of value-based healthcare. These include a) developing HTA Frameworks that are progressive with assessments and are based on real-world usage and outcomes, b) consider the clinical and economic impact of a technology over the total cycle of care as part of the value framework, c) tailor HTA value frameworks to different TAs, medical devices, digital health, and diagnostics. d) increase transparency and multi-stakeholder integration in the HTA process, and e) invest in data infrastructure to support the assessment process.
Dr. Guarin summarized the results of a 2016 global report including health systems in 25 countries, with 4 from Latin America (Brazil, Chile, Colombia, and Mexico), to determine their alignment with the VBHC model. Colombia was given a moderate score, while the rest scored low. He then presented results of a recent survey on VBHC in 5 countries (Argentina, Brazil, Chile, Colombia, and Mexico) highlighting overall hurdles for implementation, followed by a high-level summary of a Panel on VBHC with 3 different stakeholder perspectives (Patient, Provider, Payer, Producer). Survey results showed that most participants agreed with the definition of value (“Value is the relation between outcomes and costs needed for achieving those outcomes”). However, VBHC implementation varied across countries, with Colombia again scoring higher than the other countries. The lion’s share of hurdles for the implementation of VBHC in Latin America were given by a) healthcare system fragmentation, b) lack of integration of clinical data, outcomes and costs within electronic records, c) lack of standardization in outcomes measurement and d) lack of incentives. He concluded by illustrating what is needed to shift from volume to a value-based environment in the region, by focusing on health promotion and disease prevention, establishing integrated systems with proper health information technology, and providing the financial and non-financial incentives.
Finally, Prof. Gasparello provided a general overview of supplementary health coverage in Brazil, by reviewing market trends quality induction projects, in particular the value-based payment models project, conducted by the National Regulatory Agency for Private Health Insurance and Plan (ANS, by its Portuguese acronym). Among the initiatives implemented by the ANS in response to troubling health trends in Brazil, she highlighted the value-based payment models that incentivizes outcomes obtained from healthcare interventions. The ANS has published a guide which can be accessed here: https://www.gov.br/ans/pt-br/arquivos/assuntos/gestao-em-saude/projeto-modelos-de-remuneracao-baseados-em-valor/guia_modelos_remuneracao_baseados_valor.pdf. Several projects have been endorsed to support strategies to enable the effective implementation of new innovative payment models, focused on the perspective of improving the quality of health care and sustainability in the scope of supplementary health.
The recording of the session can be found in https://www.ispor.org/conferences-education/education-training/webinars/webinar/hta-reimbursement-evolution-and-priorities-for-assessment-in-a-value-based-healthcare-environment-in-latin-america