The search for measuring results in patient care and presenting health outcomes dates back to the beginning of the 20th century, when Ernest Codman, a surgeon from Boston (USA), published his first works on the need and importance of guaranteeing the quality of results interventions. For each patient he treated, Codman drew up a “final result card”, which contained the current history, the initial diagnosis, the treatment given, the occurrence of complications, the discharge diagnosis and the result a year later.

Since then, we had milestones in the 1960s, with the publications of the Armenian-Lebanese doctor, Avedis Donabedian, on the dimensions of the quality of the health system (structure, processes and outcomes); The creation of the US News - Best Hospitals ranking in the 1990s, which brought the first efforts to benchmark between hospitals. Also in the 2000s, the publication of the book Crossing the Quality Chasm shed light on this concept, marking the trajectory of quality and safety through a report on the quality of health care.

More recently, the concept of value in health has evolved exponentially on the world stage, due to the various challenges presented by contemporary society, among them, the population increase itself, its respective aging, and the desire and the need for access to health services. new discoveries.

The awakening to this concept had a huge contribution by professor Michael Porter, after the publication of the book Repensando a Saúde, in 2006, written together with Elizabeth Teisberg, proposing new ways of acting in the health chain that involves patients, operators, health professionals , hospitals and complementary providers. The authors encourage the integration of all players in a systemic way, minimizing imbalances and waste, thus generating more value to patients. The objective is value-based competition, where the patient starts to integrate and use a health system, according to their specific needs, and with positive results for all participants in the segment.

The patient resumes his role as the protagonist as the center of care efforts. Porter suggests a path for transforming care based on six interrelated elements: organizing your units into integrated practices, measuring results and costs for each patient, moving payments into care cycles, integrating care between health services, expanding access to excellent services, and finally, to have access to the information technology platform that acts as a facilitator of the entire process.

The debate about what value means to the patient is a paradigm shift that requires a shift from the current point of view of the actors involved to a new business and purpose perspective. In no way, it is a concept that seeks to reduce costs by itself, but proposes the rational and systemic use of resources, based on the application of data intelligence, clinical protocols, assessment of the relevance of each case, specificity and integration of data. providers, measuring expected and achieved results, and the patient's experience throughout the journey.

Cultural changes are always challenging, whether in a company or in a country. In Brazil, as well as in several countries, the implementation of changes in existing models is not a trivial task, as it requires planning and strategic vision, commercial renegotiations of traditional models, institutional serenity and transparent dialogue, always seeking to avoid abrupt disruptions, users' doubts. , and potential losses for all links involved.

The fact is that there is no perfect health model and, for this same reason, several models may coexist in this scenario, based on the premise of safe care, appropriate relevance, measurement of results and generation of value for patients. We need to be open to the continuous improvement of our practices, understanding that we are inserted in the same social fabric and that the benefit of one, can and should be beneficial for all links in the chain. Several hospital institutions have already taken the first steps in measuring their clinical outcomes and improving their practices, with significant investments in value offices, clinical controllers and the use of internationally recognized instruments such as the DRG (Diagnosis-Related Groups) and the ICHOM (International Consortium for Health Outcomes Measurement), among other available measurement tools. Unfortunately, this type of investment requires resources, which most hospital institutions do not have.

CONAHP, the main event in the health sector in the country, aims to connect the segment and its participants to the demands and challenges of contemporary society, with the objective of strategically designing the future, seeking solutions and new models inspired by the best practices and theories applied around the world, even if in the short term, doubts and discomfort are generated. In this year 2019, our congress will take place in São Paulo, from November 26 to 28, and will focus on Value-based Health and the role of the hospital as an integrator of the system. It will be a unique opportunity to discuss the evolution of the concept and the next challenges of the hospital system in promoting this change.

* Mohamed Parrini Mutlaq, President of the Scientific Committee of the National Congress of Private Hospitals (CONAHP) and CEO of Hospital Moinhos de Vento