Case Study on Changes in the Healthcare and Payment Model: The Experience of ACO Unihosp Medhealth in Goiás, Brazil

Abstract

The objective of this paper is to narrate a case study about integration of healthcare by means of an Accountable Care Organization (ACO), developed in the state of Goias, Central Brazil. The method used was a case study focusing on a partnership formed between seven hospitals and three diagnostic imaging clinics with the purpose of integrating primary, secondary, and tertiary levels of care.  The coordination of the health system is made through a hospital unit in the primary level. The proposition brings innovation in the sense that the focus changes from volume of medical procedures to the patient health wellbeing. The current healthcare context in which this case was created presents strong challenges to managers and executives in the healthcare sector: combination of overuse of the healthcare system with increasing medical costs. The results showed improvement in a set of health indicators when comparing the ACO initiative with the figures from the National Supplementary Health Agency (ANS), such as consultations per patient per year (5.5 for ANS versus 3.7 for ACO), number of patient examinations per year (23.4 for ANS versus 8.39 for ACO), X-ray examinations per patient per year (0.6 for ANS versus 0.1 for ACO), and non-surgical hospitalizations per patient per year (0.072 for ANS versus 0.008 for ACO). This study can contribute to healthcare by presenting a proposal aimed at addressing one of the major current challenges in the field: excessive use of the healthcare system on one hand and high medical costs on the other.