The Instituto Cardiovascular at HIC – FCV implemented an integrated cardiovascular care model grounded in Value-Based Health Care principles, comparing a shared-risk bundled payment model with a traditional fee-for-service payment model between 2022 and 2025. The initiative aims to demonstrate that aligning clinical integration, systematic outcome measurement, and shared financial accountability can generate measurable patient value within a middle-income health system facing a high burden of cardiovascular disease.
The program serves a socially vulnerable population characterized by progressive population aging and limited educational attainment. The largest proportion of patients are between 60 and 74 years old, reflecting the epidemiology of chronic cardiovascular disease. Educational levels are predominantly low, with 38% of patients having only primary education and 28% secondary education, while only about 21% have technical or professional training. These social determinants represent barriers to health literacy, treatment adherence, and long-term recovery, highlighting the need for coordinated and patient-centered care.
The initiative operates as a network-level model integrating multiple Cardiovascular Centers of Excellence managing acute myocardial infarction, heart failure, complex cardiomyopathies, congenital heart disease, cardiovascular surgery, and advanced cardiac support therapies. Multidisciplinary teams coordinate standardized clinical pathways, perform early psychosocial and functional assessments, and continuously measure clinical and patient-reported outcomes while aligning incentives with payers through shared accountability contracts.
A total of 8,114 patients were included, of whom 3,137 were treated under the shared-risk model and 4,977 under conventional payment. Despite the shared-risk cohort being older, outcomes were maintained or improved. In-hospital mortality was lower in the shared-risk group (3.76% vs 4.12%), representing an approximate 9% relative reduction.
Health-related quality of life, measured using the EQ-5D-3L Visual Analogue Scale (VAS), improved meaningfully during recovery in both groups. Under the shared-risk model, VAS scores increased from 71.13 at baseline to 75.17 at one month and 78.15 at six months, demonstrating sustained improvement in perceived health status. Conventional care showed a similar trajectory (73.76 at baseline, 75.24 at one month and 78.54 at six months), confirming that efficiency gains were not achieved at the expense of patient recovery or experience.
Efficiency differences were substantial. Average hospital length of stay was shorter under the shared-risk model (7.7 vs 10.6 days), and mean cost per patient decreased from COP 17.8 million (~USD 4,450) to COP 14.3 million (~USD 3,575). These improvements reflect better care coordination, earlier discharge planning, proactive follow-up, and stronger alignment between providers and payers.
Technology enables sustainability of the model. Automated clinical databases, real-time performance dashboards, and structured post-discharge monitoring, including telephone follow-up and automated digital messaging, support continuous measurement, rapid feedback loops, and long-term patient engagement.
This initiative demonstrates that a shared-risk cardiovascular care model can simultaneously maintain clinical outcomes, preserve patient-reported quality of life, and reduce costs. By aligning providers, patients, and payers around measurable outcomes and continuous performance monitoring, the program delivers tangible patient value and provides a scalable blueprint for value-based cardiovascular care in middle-income health systems.