Procurement in healthcare: how procurement migrates from bureaucracy to the concept of value
Central Purchasing Offices are evolving from simple buyers to real 'competence hubs' able to dialogue with regional planning and the market and to capture the needs of clinicians and patient associations
The procurement system, traditionally dominated by a bureaucratic-administrative approach oriented towards regulatory compliance, is showing an interesting professional ferment towards value-based logics. The change starts with some regional central purchasing bodies, especially the more advanced ones, which over the years have acquired a deep knowledge of market dynamics and can therefore open up to innovative processes with greater confidence. Value-Based Procurement (Vbp), born on the wave of Value-Based Health Care, shifts the focus of procurement from mere technical specification and price to the logic of value - clinical and/or organisational - throughout the entire contract life cycle.
The forerunners
To date, about thirteen tenders have been carried out according to this logic, with Estar, the central purchasing body of the Region of Tuscany, assuming a leadership role. Other experiments have also been conducted by Intercent-ER, Aria and Consip. These experiences outline a clear trajectory: the central purchasing bodies are evolving from simple buyers to real 'competence hubs', capable of dialoguing with regional planning and the market, and of grasping the needs of clinicians and stakeholders - such as patients' associations - by exploiting networks, information assets and knowledge acquired over the years. This change is also made possible by the search for new intellectual and professional challenges on the part of the professionals of the centres and healthcare companies.
You need a strategy
Although today the payment by result and payback approach still prevails, and therefore risk-sharing mechanisms, the dimension of the collaborative process that builds value is increasingly emerging. To prevent this innovation that the NHS needs from remaining isolated to a few experiments carried out by a few heroic buyers, due to the difficulty of defining baselines, creating outcome collection systems or identifying the most appropriate indicator on which to base payment - all factors that impose fairly high administrative burdens and could discourage the possibility of transforming this approach into a maintream - we need to adopt a less transactional and more strategic vision of Vbp.
The 'value' at the centre
To respond to this challenge, the Masan Observatory of SDA Bocconi School of Management, working with the main regional central purchasing bodies, some healthcare companies and market operators, has defined a process-oriented, evolutionary and adaptive approach to Vbp, which places dialogue with stakeholders and gradual learning at the centre. 'Evolutionary', because it requires incremental steps; 'adaptive', because it must be able to function in different territorial and product contexts. The approach places stakeholder dialogue and solution co-design at the heart of the value creation process, which is by its very nature a changing concept. Thus, the focus is not just on monitoring clinical data and outcome-related payment, but on sharing what creates value and how it can be created within organisations. Outcome-related payment can be an accelerator for introducing technological innovations and sharing risks, including through ad hoc monitoring systems. Once the evidence is consolidated, purchasing can re-enter the mainstream with simpler rules. Adopting payment by result logic on established solutions does not make much sense unless initial steps are required to build confidence, train skills and reduce risk perception.
From test to established practice
However, in order for a VBP approach to become truly mainstream - widespread and not limited to a few pioneering cases - it is necessary to act on a number of enabling conditions: strengthening the strategic skills of public buyers, favouring transformational managerial training courses; integrating information systems for monitoring and measuring results, also thanks to artificial intelligence solutions; and making budgeting and reporting mechanisms more flexible, so as to allow investment today to generate future benefits. Finally, a cultural change is needed in corporate strategic management, which must recognise procurement not only as an administrative function, but as a lever for innovation and the creation of value for the NHS.
This is the condition for transforming Vbp from a courageous experiment to a consolidated practice: a flexible, adaptive and collaborative approach, capable of generating value for citizens and strengthening the sustainability of the healthcare system. Finally, it is necessary to continue with initiatives aimed at experimenting and sharing the results, in order to foster a transversal, flexible and adaptive adoption of Value Based Procurement and greater trust among all stakeholders in the system.
